In nursing practice, healthcare providers face various ethical and legal issues in the process of treating patients. An example of an ethical issue is the concept of informed consent. The scenario of informed consent can be described as a point where permission is granted to a doctor or any medical personnel to conduct a medical procedure on a patient. The process should be within the knowledge of the patient in regard to the possible risks and consequences which might arise. This article is a comprehensive discussion on informed consent and how it impacts the process of providing healthcare services by nurses.
Background Information on Informed Consent
Before the onset of the idea of informed consent, most of the medical personnel used deception in conducting most medical procedures. This took part for several years as the doctors perceived deception as a standard mode of medical practice. In ancient Greece, it was considered undesirable for patients to make decisions regarding medical procedures conducted on them. Currently, the concept of informed consent is backed by theory, ethical underpinnings, and the law. The idea is in line with the concept of autonomy which requires that one should accept a given practice as a mode of independent reasoning. Katz, Webb, and Committee on Bioethics (2016) claim that informed consent involves two major duties which include disclosing of medical information to the patients’ families obtaining the legal acceptance before commencing any medical procedure .
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Inasmuch as patients have the autonomy in providing consent, they should not be incapacitated while making such crucial decisions. With this, it is expected that there should not be a heavy reliance on individual patients to make decisions in regard to medical procedures. Hence, the consent of their family members is in most cases considered. There are incidences where informed consent is needed in the conduction of medical research. In such cases, it is better to highlight the costs and benefits to the society so as to increase the chances for participation as can be seen the research is key for mitigation findings (Limkakeng et al., 2014).
The Process of Seeking Informed Consent
There are laid down procedures that medical practitioners use to acquire informed consent from a patient and their families. The acquisition of informed consent approval is not just certified on the basis of existing signatures. It is initiated through a dialogue between the doctor and the patient. The initial stages of dialogue entail the emancipation of the expected information to the patient and their families by the doctors and nurses. The medical practitioners are supposed to assess whether the patient has the capacity to make a rational decision. An assessment is also supposed to be done on whether every competence has been adhered to so as to make the decision legal.
As stated earlier, the dialogue between the patient and the doctor in the presence of the patient’s family provides information and an in-depth explanation of the patients’ condition. The medical practitioners should make it absolutely clear to the patient using simple language. The patient is informed of the risks involved and the potential benefits which may accrue on the process. Importantly, the patient is told of other available alternatives and their effects and advantages. Also, the explanation extends to giving details on whether there are no options for treatment. The process of giving information to the patient regarding the risks and alternatives of any medical procedure forms closer relationships between patients and their doctors and nurses. ( Spatz, Krumholz, & Moulton, 2016). It is logical reasoning that the patients and doctors would build a good rapport once the patients learn that their decision is key in their treatment process. The second activity in the process of acquiring informed consent is the assessment of the understanding of the patients in line with the explanations made in the first phase of the process. It is important to put into consideration that the next process should not be commenced until the patients have satisfactorily proved that they understand the gravity of their decision.
After the assessment of the understanding, there is the assessment of the decision making. It is argued that decision making is a challenging and critical requirement, the patients and their family members should be assessed simultaneously. Assurance should be secured as to whether the process and the decision made by the patients and surrogates were voluntary and void of any coercion and manipulation. This is informed by the fact that most of the people in the world are exposed to subtle pressures when endeavored with obligations of making decisions. Again the decision-making process involving the medical issues should be treated to with concerns as they are informed by other interrelationships and factors.
The process of acquiring consent should not involve any other physician. It is recommended that the doctors who should conduct the process are those with senior and vast medical experience. It is considered unethical and illegal for junior medical personnel to engage in the process. On the side of the patient’s family members, a junior member of the household should not be considered in the first step of the process which involves an explanation of the process thus their participation in the process should not be assessed.
Standards for Decision Making in the Informed Consent
There is a need to understand that the issue of consent is much influenced by the individual upbringing where there are elements of distancing oneself from any aspect of confrontation. To the pediatrics and healthcare professionals, it is important that one develops a good understanding of respect for the autonomy of the patients and their family. In particular, there is a need for the incorporation of respect for the medical history and experiences of the patient. Also, nurses should be cognizant to the fact that family is marked by features of dynamics which is likely to affect the entire medical activities of a given member. Before the nurses engage in the modalities and best models to incorporate, it is good to understand the possible complexities which are involved in the decision process made by both the surrogates and the patients.
There are factors which influence the decision process of informed consent. These include factors such as emotions, the relationships between the surrogates and the patient as well as the doctors. Faith and health status are some of the considerations put into place in the entire process. For most adults, the surrogate consent is determined through the use of a standard concept known as substituted judgment. In most situations, the parental decisions are treated with more seriousness as compared to other surrogates especially in the case of infants and young adults. However, it should be noted that their decision is not given absolute totality. As part of pediatric and other healthcare providers, it is expected that the medical givers have the duties both legal and ethical to ensure that they follow the medical need and they respond to the requirements of medical situation a patient is in need to have treatment. There is a need to bring on board some standards which regulate the clinical activities and at the same time put into consideration the protection of the patients’ rights ( McKinney Jr. et al., 2015). This shows that in case there is any point that the decision may conflict with the medical need of the patient, it is necessary that the nurse takes the part of the medical obligation to supersede the decision made.
The publication of the AAP statement took place in 1995 and since then, there has been the emergence of different literature geared towards ensuring that there are modalities and good channels for the operation. These standards vary in application between the children and adult population. For children, it is expected that their parents and medical practitioners observe the best interest as a modality for decision making for children. With the best interest, there is an expectation that there is the maximization of benefits and reduction of risks and adversities. There have emerged challenges in the application of this standard of best interest in that there is no consideration of other factors such as the family financial statuses. It is required that the principle of best interest is applied holistically to include factors such as emotions, family financial positions, and medical concerns.
It becomes necessary that there should be reached an ideal situation but not an absolute position in the application of this standard. Another standard which is taken as an option is the harm principle. This is in most cases applied when there is the concern about the safety of the patient it is mostly applied in case of children. The major aim with this principle is that there is no single consideration like the best interest of the patient or the surrogates like the parent to a child. The point is the assessment of the decision made by the surrogate whether it attains the harm threshold at which the decision made by the surrogates should not be tolerated. Nevertheless, in making such decision consideration is given to the potential harm the surrogate decision may have in which if it supersedes the state requirement, then it cannot be considered.
Emergency Exceptions to Informed Consents
In the case of the children, there is a need for parental consent so as to enhance the evaluation of pediatric interventions. Nonetheless, there are cases in which a child or a patient may be presented with emergency medical conditions which need quicker intervention. In case the parents or any other surrogates are not present to give consent, APP framework recommends that medical examination and screening, as well as the stabilization, should not be withheld due to the consent. It is required that the process of medication should be carried out. In some cases, clinics, parents or even the courts may challenge this decision basing the argument on the procedure for establishing the emergency. This is the reason as to why it is required that the decision is taken when there is the eminent reason for the procedure and that there are no other options. Evaluation should be carried out to ensure that the process is conducted to prevent potential threats to the health of a patient. Again there should be assurance and affirmation from the medics that the surrogates cannot be reached at the time. In doing these the pediatrics should be cognizant of the fact that lack of informed consent may be treated as negligence. The physician may not be held liable of malpractice in case of the eventuality of the patient but can be held liable for not obtaining informed consent ( Moore, Moffett, Fider, & Moore, 2014). Therefore, informed consent should be treated with care it deserves as it can lead to a legal contest whose lability can be narrowed down to doctors or any other medical personnel.
Conclusion
It can be concluded that the doctors’ decision should supersede the decision from the family memebers and the patients. However, the ethical consideration in such scenarios should be overly exploited. Therefore, further undertakings should be carried out in regard to informed consent so as to build a good situation for all parties concerned.
References
Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics , e20161485.
Spatz, E. S., Krumholz, H. M., & Moulton, B. W. (2016). The new era of informed consent: getting to a reasonable-patient standard through shared decision making. Jama , 315 (19), 2063-2064.
McKinney Jr, R. E., Beskow, L. M., Ford, D. E., Lantos, J. D., McCall, J., Patrick-Lake, B., ... & Weinfurt, K. (2015). Use of altered informed consent in pragmatic clinical research. Clinical Trials , 12 (5), 494-502.
Moore, G. P., Moffett, P. M., Fider, C., & Moore, M. J. (2014). What emergency physicians should know about informed consent: legal scenarios, cases, and caveats. Academic Emergency Medicine , 21 (8), 922-927.
Limkakeng, A. T., de Oliveira, L. L. H., Moreira, T., Phadtare, A., Rodrigues, C. G., Hocker, M. B., ... & Pietrobon, R. (2014). Systematic review and metasummary of attitudes toward research in emergency medical conditions. Journal of Medical Ethics , 40 (6), 401-408.
