informed consent

NURSING AND MIDWIFERY

ETHICS

ANTOINETTE ATTARD

informed consent

Questionnaire

33 Candidates

Departmental Nursing Managers

Nursing Officers

Deputy Nursing Officers

informed consent

‘Which are the common ethical concerns you

encounter in your clinical area?’

Theme Occurrence

Information giving

Truth telling

Chronic conditions

Separated parents

16

Confidentiality

Same locality

HIV

Relatives

9

Letting die 6

Accountability

Reporting

Ward management issues

Resources

Priorities

5

2

3

Table 1: Common Ethical concerns you encounter in your clinical area

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Information Giving and Informed

Consent

informed consent

“nurses and midwives should: within their sphere of

responsibilities, ensure that patients / clients are given

adequate and correct information enabling them to make

a free informed choice as to the provision of their own

care” (Nursing & Midwifery Board 1997)

informed consent

Patient Charter (2001) dedicates a

whole section (Section 2) to Informed

Consent

informed consent

‘Do relatives have a right to

request to withhold information

from patients?’

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Table 2: Do relatives have a right to request to withhold information from patients?

Response Occurrence Comments

No 17 Patients have a right to

information

Patients have a right to `all care’

I would want to know

Yes 12 Relatives know the patient best

Relatives can prepare the patient

first

Relatives can support patient

Patient may commit suicide

Unsure 3 Depending on the patient

I would not be ready to lie to

patient

informed consent

‘Patients have the right…for their

condition not be divulged to next

of kin, if patients so request in

writing’ (HMC 2001)

informed consent

Informed Consent

Accurate and Adequate Information

Time

Clear Language

informed consent

Informed Consent (cont)

Patient’s mental ability to understand

Knowledge `parity’

informed consent

Informed Consent (cont)

Reasoned Decision

Patients - free to decide

Can form an open and undistorted judgement

Take responsibility for they actions

informed consent

Informed Consent (cont)Valid Consent

For invasive procedures & blood transfusions – signed consent form

Signed by patient who is informed

Witnessed by doctor

Allows for rerservations

informed consent

Informed Consent (cont)

For non invasive procedures

Informal consent – accepting procedure

such as giving hand to take bloods,

accepting drugs etc

informed consent

Common questions

How much should one tell?

informed consent

Standards of disclosure

Professional practice standard

The reasonable person standard

What a particular patient may need

informed consent

Common questions What if the patient cannot cope with the information?

What if the patient is not competent to decide?

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A person is competent if and only if that person can

make reasonable decisions based on rational reasons.

In biomedical contexts this standard suggests that a

competent person is able to understand a therapy or

research procedure, to deliberate regarding major

risks and benefits, and to make a decision based on

this deliberation

informed consent

Informed Consent (cont)

There should be a moral presumption in

health care – parallel to the accepted

legal presumption – of an adult’s

competence to make decisions.

informed consent

Informed Consent (cont)

The burden of proof would then fall on those

who believe that a particular adult is

incompetent to decide, to establish a patient’s

incompetence in order to disqualify him or

her from decision making

informed consent

Common questions

Should one just volunteer information or wait to be asked?

informed consent

Informed Consent (cont)Health Care Professionals stand in a special `fiduciary’ relationship – that is of trust and confidence, to their patients and thus have an affirmative obligation to disclose information as opposed to a salesman selling a product who cannot lie, but is under no obligation to volunteer information

informed consent

Main Components of informed Consent

Choice – there is always an alternative

Voluntary – free from coercion

Competency – able to make a choice

Understanding

informed consent

Informed Consent Essential for

Any Treatment

Diagnostic Procedures

Participation in Research

informed consent

Thank you for your attention.