The topic I chose is informed consent. It is a difficult and complex topic with many different laws and viewpoints. The laws of consent often vary by state and in my opinion are often not fully understood by many people. There are many ethical issues that can take place from not completely understanding the consent form. Many people do not read the form at all and consequently do not know their rights as a patient. Patients sometimes sign the consent form without fully understanding everything that is required for them to know. When an issue comes up it can then quickly escalate to an ethical issue that can only be resolved in court because they were not aware of all the possibilities. Patients must not agree to the consent form without being entirely aware of all the possibilities. Nurses and physicians can be extremely busy and overwhelmed. Heath care professionals should have the time to go over all aspects of the consent form to help prevent an ethical issue.
In my essay I will explain the basics of informed consent, ethical issues associated with informed consent, some of the problems with the consent form itself, and some theories that may improve the consent form. It is imperative for heath care professionals and patients to be educated about the consent form and specifically what their states laws are regarding consent. Many people do not know the meaning of “informed consent” and how important it is for the patient and the heath care industry.
Informed consent gives the authority for heath care workers to treat patients. According to (Taylor, 2008), “informed consent is a formal authorization by the child’s parents or guardian allowing an invasive procedure to be performed or for participation in research.” Usually before a heath care profession can even touch a patient a consent form must be signed. Informed consent is required in all heath care agencies. It is vital that the health care workers and patients understand what the consent form consist of and that they make sure that all elements are present before obtaining consent.
To obtain consent these basic elements must be included. The patient or guardian must be informed about the procedure and all the possible outcomes, alternatives, risks, and must understand that there is no certainty on outcome (Taylor, 2008).They must also understand why they are giving consent and should be able to repeat in their own words for which they are giving consent. It is a must that they are competent in their decision. To achieve this they must not be under the influence of any drugs, stress, pain, or any thing else that could distract them from the ability to make a decision. The patient must also be willing to give consent and must not be forced into any decision. The patient must also be informed that they are able to refuse treatment at any time without penalty. If consent is not obtained or doesn’t contain any one of these elements it is punishable by law. The nurse can lose their license or even be charged for battery (Taylor, 2008).Health care professionals need to know their role in obtaining consent and it is usually a team effort in doing so.
The physician is the one who must obtain consent but before the physician makes an attempt to do this they must explain the procedure to the patient or guardian and abide by all the elements. (Tomes, 1993) The nurses role is to sign as a witness and make sure that consent was signed by the patient or guardian and that all the elements were achieved (Ball, 2008). Plus the nurse is able to answer certain questions the patient has before the procedure. Exceptions are made if the patient is in a life threatening situation and there is no time to get consent or the patient is not able to give consent (Ball, 2008).
It is the physicians and nurses duty to give medical treatment. The topic gets more complicated when a child that is not legally able to make decisions for their own well being and relies on their guardian or parent to do so.
For children and young adults to receive medical treatment they require their parents or legal guardian to authorize consent for them. According to (Taylor, 2008) they are considered to young and immature to use abstract thinking. The decision to sign consent and go forth with a procedure, or understand a procedure and its potential outcomes can be very difficult for the parent as well. Parental consent laws are also different in every state and can be very complex. For instance, Oregon allows minors that are fifteen to give consent without a parent or legal guardian and the age is even lower in Alabama (Taylor, 2008).
There are also many different exceptions on the child obtaining their own consent and it all depends on the patient’s state laws. Some of these exceptions include: a minor who has a child, emancipated minors, adolescents seeking birth control, and in some states the minor must convince a judge that they are competent enough to obtain consent for treatment without parents or legal guardian. All of these different exceptions make room for many different ethical dilemmas.
A minor who has a child has consent over their newborn but not over their own self can be a major issue. Often the parents of the child may have conflicting interest. According to the planned parent hood website in the state of Nevada adolescents do not need any parental involvement at all to receive an abortion, birth control, or be tested for a sexually transmitted disease. In fact it is the patients right for their information to not be disclosed to the parents (Parental Consent and Notification Laws, 2009).These issues raise eyebrows and are not accepted by many people who believe differently due to moral, cultural, and religious beliefs. Others believe other wise due to the same values.
Conflicts of interest between the child and the parents happen but not always do the parents have control or absolute authority over what medical treatment the child may have or may not have. There are different situations that the child may over rule the parent’s decision. For example, if there is a conflict of interest, if the parents do not permit life saving treatment for the child, or when there is a possibility of child abuse or neglect. An ethics committee may be appointed to the family to help resolve the issue (Ball, 2008).
A conflict of interest between the parents and child could mean that the child wants to withhold all medial treatment because they know they are terminal but the family wants to continue all medical treatment until the end. An example of when the parents do not permit life saving treatment for the child is when they refuse a blood transfusion due to their religious beliefs. Sometimes the parents are abusive or neglectful and chose not to treat the child medically. It is the health care workers responsibility to report any kind or neglect or abuse to the authorities.
In many of these situations the family’s were fully aware of their rights of consent and understood all the possible outcomes and risks. There is not always a right or wrong answer and many of these situations end up in court. Other issues could be avoided if the patients were more educated on their rights. It is not always the patients to blame.
In my opinion there are many problems with the form itself. The typical length of the form is twelve to fifteen pages long and the form is usually given to the patient right before the procedure. At this time the patient could be under stress from being in the hospital or feel pressured to hurry up and sign the consent form. The patient could also be intimated by the long informative form and not even make an attempt to understand it. Also health care worker may not go over the form thoroughly enough because the patient just signed the form without looking it over. Health care workers could even feel rushed to get the form signed for the physician. From experience the consent form seems like an information overload other than an educational experience. Often people have a hard time understanding and remembering what the physician is talking about because they are speaking in medical terms.
There are many different ways the consent form could be improved for the patient to understand. In my opinion the form should be a lot shorter and be at least at an eight grade reading level. It should be given to the patient to sign as soon as possible not right before a procedure if feasible. This way the patient will be able to go over the material on their own time and not feel pressured into anything. There should be a class to go to if the patient does not feel comfortable or knowledgeable with the consent form. It should be more of an educational experience for the patient.
In conclusion many of these ethical issues can be very difficult for people and the right answer sometimes is which ever answer the patient chose’s for which ever reason. As heath care professionals it is our obligation to give the patients all the correct information so they can make their best judgment.