Language Barrier and Informed Consent in Operating Theatre - Case Study Example

Language barrier and informed consent in operating theatre Your name:   Course name:         Professors’ name: Date: Word: 1811 Clinical Scenario: Mr. Franklin, a 29-year-old, a Spanish Nationality with Limited English Proficient (LEP) was placed under my care during my clinical placement. On further inquiry, the patient had developed complications with his testicular torsion while on site seeing. The patient was rush to the hospital by his Spanish friends who were with him at the site seeing. The patient was then admitted to the emergency room with testicular torsion because of extreme pain. Mr. Franklin was scheduled to undergo an emergency surgery, but the operating doctor (surgeon) was unable to see the patient for at least 30 minutes. He asks that the patient not be given any pain medication, so that "consent can be obtained" when he sees the patient. The situation was further complicated because the patient was a first time visitor in Australia and had limited English Proficiency, so there was need for a Spanish interpreter before an informed consent was to be obtained. Professional Issue: In the case scenario, the operating doctor (surgeon) has misconception that patient’s informed consent is invalidated by the presence of medications (Aveyard, 2008). A patient who has been presented to undergo surgery may be given a variety of medications; some of these medications may have effects on the patient’s mental function (Behnke, 2004) (Katz, 2005). The issue in the clinical scenario is not the patient has been pre-medicated (Toulson, 2006), but whether pre-medication has affected the patient’s ability to participate in the informed consent process (Beauchamp & Childress, 2009). While the ethical issues that has been presented in the clinical scenario include assessment of the patient’s mental capacity to make decisions, and whether the patient was deliberately being forced into consenting for operation (Desai, Minassian, & Reidy, 2005). My role in this scenario was to interface and prepare the patient to be ready for the surgery. Not only was my duty of care to take into consideration weight, age, and assessment of health issues but also cultural and linguistic issue that may influence the patient’s direct healthcare management (Berg, Appelbaum, Lidz & Parker, 2001) (Toulson, 2006). After preparing for emergency surgery, it was my role to conduct an interview and assess the patient before moving the patient to the surgery or operating room (Hunka, 2006). During the interview, I found out the patient had limited English proficiency (Behnke, 2004) (Hunka, 2006). It was important that the patient, regardless of the language barrier, was fully informed regarding the emergency operation he was being prepared to undergo (Beauchamp & Childress, 2009). It was my role to fully inform the patient of the potential benefits and risks, and establish whether or not the patient consents to emergency surgery (Katz, 2005). Nurses in the emergency room should avoid using patient’s bilingual family members, friends and children as translators (Desai, Minassian, & Reidy, 2005). Using these familiar individuals as interpreters seems like a quick fix, but they may misinterpret or dilute the interaction at best in the worst case scenario (Berg, Appelbaum, Lidz & Parker, 2001). My role in the emergency room was to find the best form of communication with the patients since I did not understand or speak Spanish. After completing preparing the patient for the surgery, I was able to locate the nearest Language Line telephone that was found in the hospital (Aveyard, 2008). This special telephone line has two telephone receivers (LeBlang, Rosoff & White, 2006). Only the nurse and the patient are on the line, simultaneously speaking with a trained interpreter (Desai, Minassian, & Reidy, 2005). After, the interviewing the patient, and informed consent was obtained from the patient; the patient was able to sign the Spanish side, where the Language Line operator’s number was clearly written, along with the intended surgery, the signature of a witness like a registered nurse and the date and time was also provided in the informed consent sheet (LeBlang, Rosoff & White, 2006). Analysis: For consent to treatment or surgery to be considered valid, it must be an “informed consent (LeBlang, Rosoff & White, 2006). The patient should be given enough explanation about of treatment and its outcome as well as risks involved and alternative available (Grisso & Appelbaum, 2007) (Toulson, 2006). The information that is given to a patient who is about to undergo an incisive procedure must be that that allow the patient to make an informed decision (Hunka, 2006) (Longo, 2007) (Van Kleffens & Van Leeuwen, 2005). In a situation where the patient is not able to make an informed decision, the discussion must take place with the substitute decision maker (Katz, 2005). The ethical principle of respect for patient autonomy is the basis of the requirement for informed consent (Behnke, 2004). The main autonomy-related issue in this case scenario is the prima facie duty of the surgeon to obtain informed consent (Hunka, 2006) (Skene & Smallwood, 2005). Obtaining informed consent from a patient is important in this case scenario given the invasiveness of the procedure, the short term harm to the patient, and the temporarily unconscious state of the patient during the procedure (Behnke, 2004) (Van Kleffens & Van Leeuwen, 2005) (Skene & Smallwood, 2005). The duty to respect the rights of a patient is self-determined and this mean a patient has a right to be left alone in making a free choice concerning treatment (Aveyard, 2008) (Skene & Smallwood, 2005). According to the Belmont Report (1979, p. 23 as cited in Behnke, 2004), “respect for patient incorporates at-least two ethical convictions (Levine, 2006): first, that patient with diminished autonomy is entitled to protection (Longo, 2007), and second, that a patient should be treated as autonomous agents (Ibrahim, Kwoh & Krishnan, 2007) (Hunka, 2006). The ethical principle of respect for patient autonomy is divided into two moral requirements: the requirement to acknowledge autonomy of a patient and the requirement to protect a patient with diminished autonomy." (Grisso & Appelbaum, 2007). The surgeon in the case scenario had a common misconception that informed consent can be nullified by the presence of specific medications (Berg, Appelbaum, Lidz & Parker, 2001) (Skene & Smallwood, 2005). A patient who has been rushed to the hospital may have been given medicines; many of these medications may have an effect on the patient mental function (LeBlang, Rosoff & White, 2006). In the case scenario, Mr. Franklin was being coerced into consenting for surgery which goes against ethical principle of respect for patient autonomy which requires a patient to be given a free choice concerning treatment (Beauchamp & Childress, 2009) (Longo, 2007). Mr. Franklin capacity to provide informed consent must not be determined by recent medications that he was given (Hunka, 2006), but by whether he understand the need for surgery, can listen to and understand other treatment options and their risks, and he can be able to express a choice regarding his treatment (Berg, Appelbaum, Lidz & Parker, 2001) (Sokol & Wilson, 2008). Respect for patient autonomy requires doctors or nurses to promote a patient’s ability to make an “imaginative” choice. Severe pain, by impairing Mr. Franklin’s ability to listen and understand is against the informed consent process. Further, not giving Mr. Franklin medication to relieve his pain in-order to obtain treatment consent is coercive. Good communication between a physician and a patient is also another issue that has been captured by several principles (British Medical Association, 2002). Poor communication, both in the pre-surgery conversation about benefits and risks and post-surgery complications, can lead to considerable and avoidable emotional distress (British Medical Association, 2002). Surgeons are required to communication appropriately to patients who are undergoing surgery (Skene & Smallwood, 2005). For example, in my case scenario, the surgeon interaction with Mr. Franklin was inappropriately rude. Because of understaffing and fatigue he took more time before attending to the patient. In addition, there was sub-standard communication such as insufficient or unclear derailed instructions which reduced my efficiency while attending to the patient. This being my first time attending to a patient suffering from testicular torsion it took me more time to figure out what do. Read More