Consent

cosent的思维导图，分享了Introduction、Components of informed consent、Exceptions、Application to case.

Consent

• Introduction
  • Define
    • The plaintiff’s consent to the alleged trespass is a total defence to a claim. Consent may be given expressly by words or be implied from conduct. A person is deemed to consent to a reasonable degree of physical contact as a result of social interaction
      • purpose
        • 1. set out key underlying legal principles relevant to consent
        • 2.ensure there is a consistent approach in seeking and documenting consent to treatment across the WA health system
        • 3.support a collaborative healthcare culture that encourages patients and their families to ask questions, be presented with information about treatment options (including to take no action), have their choices heard and respected by health practitioners and involve their family/loved ones in discussions as they choose.
  • Governed by
    • Electronic Transactions Act 2011
    • Mental Health Act 2014
    • Guardianship and Administration Act 1990
    • Human Tissue and Transplant Act 1982
    • Children and Community Services Act 2004
    • Commonwealth Family Law Act 1975
    • Civil Liability Act 2002
  • Type of consent
    • Express
      • Verbal
      • Written
        • Explicit consent form
          • must be obtained and recorded in writing before proceeding with any of the following treatments (other than in an emergency) requiring general, spinal, epidural or regional anaesthesia and intravenous sedation
            • Surgical
            • Medical
            • Obstetric
            • Oncology
            • Endoscopy
            • Dental
            • Radiology
            • Mental health
        • Generic consent form
          • Patient consent to treatment – adult or mature minor
          • Consent for a minor requiring parental/guardian
          • Audltes without the capacity to consent
          • Patient consnet to anaesthesia
          • Blood and blood products
        • Duration of consnet
          • Till patient withdraw
          • The proposed treament in nolonger appropriate due to change in a patient's circumstances
          • 12 months for blood transfusion
    • Implied
• Components of informed consent
  • Voluntary
    • The decision must be made by the patient themselves
    • Must not be unduky influenced by heath professionals, friends or family
  • Informed
    • The patient must receive sufficient information about the proposed treatment to enable them to make an informed decision
      • Introduction
        • Introducing yourself
        • An explanation of the patient’s condition and diagnosis (including any uncertainty in the diagnosis and prognosis)
        • Name of the advised treatment
      • Explaning
        • Nature and purpose of the treatment
      • Benefits and risks of treatment
        • The likely outcomes of the proposed treatment
        • Outcomes which are inevitable if the proposed treatment is performed
        • The likely consequences of delaying or not choosing to have the proposed treatment
        • Any follow-up treatment or care which may be required
        • The risk that no benefit will be achieved or that the condition will deteriorate after the treatment
      • Aternatives
        • Other options for treatment
        • May include their risks and benefits too
      • Consequences of refusing the treatment
        • the patient’s right to refuse or withdraw their consent at any time prior to the treatment
        • risks and benefits of delaying or not receiving the proposed treatment
        • any short or long term side effects of the proposed treatment (including emotional, physical, psychological, social and sexual effects)
        • material risks inherent in the proposed treatment
  • Capacity
    • Given by a patient who has capacity (see Glossary) to understand the information presented to them and to make a decision. Capacity may be diminished by illness, age, medication, drugs and alcohol (amongst other things)
      • Patients with low English proficiency or special needs
        • Patients may require language services such as interpreting and translations. If an interpreter is used, the interpreter’s declaration within the consent form must be completed or be documented elsewhere within the medical record.
  • Current
    • Consent must be reviewed if, after consent was obtained, the patient’s circumstances (including treatment options and risks) have changed
  • covers the treatment to be performed
    • Treatment provided must fall within the scope of consent that has been given by the patient.
• Exceptions
  • No Consent
    • Emergency
      • Life threatening situation
      • Possible serious health impairment
      • No Advance Health Directive or Common Law Directive that is known, immediately available and applicable in the circumstances
        • 1. No capacity to mask decision
        • 2. Unable to give consent
      • Emergency psychiatric treatment
  • Consent from others
    • Minors
      • Under 18 yeras old
        • Some laws specify that treatment either may be provided, or must not be provided, regardless of whether the patient, or person authorised to make treatment decisions on their behalf, has provided consent.
        • If a health professional believes that a treatment decision made by a parent or substitute decision maker is not in the child’s best interest, this should be referred for legal assistance (see Glossary) as necessary.
      • The Enduring Guardian with authority decides
      • Minor's wishes have ti be considered
      • Must act in the best interest of the minor
    • Incompetence
      • adult patients lack capacity to provide consent themselves
        • health professionals are required to ascertain whether the patient has made: a formal Advance Health Directive (AHD) which covers the decision to be made or a common law directive that covers the decision to be made.
          • yes
            • The State Administrative Tribunal (SAT) can make a declaration that the AHD is valid (or invalid). Where there has been no application to SAT for a declaration of validity the AHD may still be persuasive as a common law directive, depending on the circumstances. Treatment should be provided in accordance with decisions expressed in AHDs and generally ‘persons responsible’ cannot override these decisions.
          • no
            • If an AHD doesn’t cover the treatment decision to be made, then a ‘persons responsible’ should be identified.
              • Hierarchy of decision makers for treatment decides
      • Treatment of patients with mental illness
        • Voluntary mental health patients
        • Involuntary mental health patients and mentally impaired accused
  • The law either permits or forbids treatment and consent is immaterial
    • Some laws specify circumstances in which treatment either may be provided, or must not be provided, regardless of whether or not consent has been provided by the patient or a person authorised to make treatment decisions on their behalf.
  • Court order
• Application to case
  • who
    • Elliot ( patient)
      • 14-year-old boy
        • conscious and responsive to questions
        • has pexpressed dissenting views from parents' religious beliefs
        • wants doctor to give him a blood transfusion without telling his parents
    • Elliot's parents
      • Jehovah's Witnesses
        • Refused blood prooducts based on their religious beliefs
        • Give consent for surgery
    • Doctor
    • Registered Nurse
    • Challenges and issues
      • Religious Beliefs: patients and parents may have religious beliefs that influence their treatment decisions
      • Minor's Dissent: Note that Elliot, being 14 years old, has expressed dissenting views from his parents' religious beliefs
    • Link to informed consent and consnet from others
      • Explain that informed consent involves providing the patient with information about the procedure and its risks, benefits, and alternatives.
      • Highlight that patients have the right to make decisions about their care, including the right to accept or refuse treatment.
      • Mention that in the case of minors, parents or legal guardians typically provide consent
  • Where
    • Hospital
  • What happended
    • Elliot was hitted by a car
    • Healthcare team suspect Elliot has a rupturned spleen
    • Elliot needs a surgery and a blood transfusion before surgery
• Best practices
  • Communication: Emphasize the importance of open and honest communication with the patient.
  • Respect for Autonomy: Highlight that respecting Elliot's autonomy is crucial, especially considering his dissent