Informed Consent in Healthcare - Essay Example

Informed Consent in Healthcare Students Name Institution Supervisors Name Date Introduction It is vital for a doctor or nurse to provide advice to and educate the patient in regards to their best interest of their health while they make their decisions which should be based on the information they have for instance, people from the west decide their own health treatment and choice, the Asians however make consultations to their families before making a decision (Grisso & Appelbaum, 2007). Permission which is granted after an individual has been well informed is an active, thus there is shared decision making process between the recipient and the providers (Brown & Edward, 2012). Legally, it is seen that the patient receives the knowledge required for them to make relevant decisions and they allow healthcare to be provided to them. (Queensland Government, 2011). Ethically, it shows the respect for a patient’s anatomy and sees the right for each person to make a decision about their lives and body. Permission granted after one has acquired the needed information is however divided into two; implied permission and explicit permission. Implied permission or rather consent is one that the patient shows their agreement through his or her actions or by complying with the instructions of the health practitioner. The explicit or express consent however, is when a patient states their agreement clearly to health care. This can either be verbal or in writing. In order for the informed consent to be considered valid, four principals must be followed and they are; permission must be granted voluntarily without coercion, secondly, permission should be granted by a person capable of doing so, thirdly, consent should be informed and finally, the consent should include disclosure of risks. Gale (2014) stresses that understanding and competencies are the two vital issues in informed consent. On the other hand, Danks (2014) emphasizes on the disclosure of the knowledge provided this is to say that the therapist is obliged to explain the intervention that is relevant to the patient. While practicing nursing, the nurses do not directly offer treatment and they also do not have responsibility of getting the consent for treatment from the patient. The nurse however has to ensure that the patient understands the treatment and he or she can also be an advocate for the patient by educating or providing the needed information which would help the patient achieve their best interest of their health and health care. Also, the physiotherapist who provides treatment to the patient directly so as to improve their physical function is responsible for explaining how the procedure is relevant to the health condition of the patient and also the benefits and risks involved in the exercise. Consent is the permission that is given by a patient for a medical procedure to be done. This means that an Informed consent is a process where the client is informed of the benefits, risk and other alternative treatment so as to empower the client and enable him or her play a part and make an informed and rational decision so as to proceed for the recommended treatment. Informed consent in the medical field will thus encompass three basic concepts namely; the legal, ethical and administrative factors in medical treatment of a patient. When it comes to ethics, informed consent will safeguard and support the autonomous decisions that the client will make. Autonomy in this sense is one of the major ethical principles that are based on respect for the patient who is capable to think and decide independently for informed choices (Kim, 2009). The issue becomes more complex when dealing with pediatrics because an elder person responsible for the child’s well-being will have to make the decision for them. In legal terms, informed consent will act as defence against battery or assault and administratively. The informed consent is a process that will ensure ethical and legal aspects of informed consent are properly implemented and also documented as is required (Grisso & Appelbaum, 2007). Informed Consent Concepts on nursing ethics and Physiotherapy ethics The principles by which the pediatric nurse will conduct an informed consent procedure will slightly differ from that of the pediatric physiotherapist. However in both areas of pediatric treatment, parental consent is one of the major challenges that the pediatric nurses and physiotherapists face from time to time. This is why decision making that involves pediatric patients should flow from responsibility that is shared by both the nurse and the parents. Physiologists too should seek informed consent of the child’s parents before they conduct any kind of medical intervention (Brown, 2011). There is only one exception that physiologists get, and this is during the case of emergency. For example, when a child is involved in a tragic accident or is in urgent need of a quick operation and parents cannot be contacted. The informed consent of parents will also include all elements that come with required standards for informed consent (Wear, 2004). The physiotherapist has a duty of providing treatment to the patient while the nurse has a duty of educating the patient. The communicator among the health team however assists the patient with nursing care (Glhan, 2010). This is due to the different scope of practice thus the point of view in relation to consent differs. They however have to understand the duties of each other in order to enable them communicate and collaborate so as to promote the patient’s health (Kim, 2009). Communication is another issue among the health professionals for instance, the nurses require the physiotherapist to examine the patient in regards to their mobility hence the nurse can provide assistance to the patient with their mobility safely (Lynch, Terry, Battersby, & Smith, 2010). Differentiation between ethics and legal issues in informed consent In most Hospitals, parental permission will articulate what is the most agreeable with regard to the best interest of the child. However in the medical field usually, this stand way of making a decision will not always be easy to define. In a cosmopolitan society that we live in, there are other factors which are considered during informed consent, some of which are social, cultural and religious or philosophic positions on what is acceptable and what is not during nursing of treating of a child (Hirsh, 2010). In fact, according to the international ethical framework for healthcare that guides most of the ethical decisions, it provides for the parents with wide discretionary, an authority to raise their children. In addition, it is common that parents sometimes have been known to breach their parental obligations due to the continued call for child abuse and neglect laws. Care providers like nurses and physiologists need to justify their call to interrupt family privacy and psychological disruption when they consent to take legal steps and override with is the parent’s authority, to consent during treatment of their children (Berg & Appelbaum, 2010). When it comes to informed consent, international ethics and ethical standards reminds nurses and physiologists, to respect the parents of the pediatrics by ensuring that the parents are provided with relevant information that will enable them exercise the decision making rights for the child. According to experts in the area of informed consent, the following observations are made: First of all, the nurse or the physiologist must ensure that parents to the pediatrics are provided with explanations in their own understandable language about the nature of the disease or the condition that they are going to treat (Grisso & Appelbaum, Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals, 2010). The physiologist is also called upon to explain to the parent the nature of diagnostic steps and other treatments that will be involved. In this part the physiologists should also explain to the parent chances that are involved in the treatment, the benefits and risks of other recommended treatments. The physiologist should also provide for the choice of treatment. Secondly the physiologist also needs to provide for an assessment of the parent’s understanding of the above conditions. Thirdly, there should be another assessment if only tacit of the capacity of the child to make own necessary decisions. Lastly the parent should be given an assurance so far as possible that he as the parent or the guardian has the freedom to choose among other medical alternatives without coercion or manipulation. The main reason for having a consent process will also include the development of the pediatric comprehensive understanding of the clinical and other components of care issues, and other timely exercise by the child and active choices with regard to the medical condition that the child might be experiencing at that moment (Lynch, Terry, Battersby, & Smith, 2010). During an informed consent, as discussed in brief, the parent also has the right to refuse the treatment if he or she sees it is for the good of the pediatric, before undertaking and form of medical intervention. As parents to the child, they generally have a moral and legal right over the child, on whether to refuse the proposed medical intervention or go ahead with it (Strife, 2011). However, there are situations when the child has exhausted all the alternatives and the parent has no more decision making capacity over the life of the child. In this case, the pediatric will undergo a legally authorized form of involuntary treatment. He should be ready to respect this authority for competent child’s autonomy that may even extend to the refusal or the discontinuation of the child’s life-sustaining form of treatment (Wear, 2004). There are also the normal traditional notions where informed consent will also look at parents who have reached the legal age of majority. However, this may not be the case if the parent is found to be incompetent. To add on this concept, the country’s laws on pediatrics designate two settings where children have the basic authority to make decisions with regard to their health. In this case, the child is looked at as being free from their parents control and is treated as adults in all components of the care. A child who is able to make their own medical decision should be one who is self-supporting or is not living at home, for example high school children. Or one who is married, pregnant or is already a parent or in the military and the court has also declared that he is freed or emancipated by the law (Clarke & Oakley, 2007). In most countries, the law would give decision making authority, with no need for parental involvement, to children who are not emancipated but have the mature decision making capacity. This will also include children who are seeking treatment for particular medical conditions like diabetes, sexually transmitted infection, pregnancy, and alcoholism and drug abuse. It is only the statute and case law that can provide situations to which children are said to be totally or partially emancipated to make own decisions, however this will vary from one country to another. Legal authority for informed consent will most of the time recognize a special status like independent living or personal health problems that may not actually be receiving special attention. Like for example, when a 14 year old contracts sexually transmitted infection (Clarke & Oakley, 2007). There are also situations where the nurse or the physiologist will have to take authority and provide treatment as appropriate. This will happen when a persistent refusal to consent may provide danger to the child, especially if the action by the physiologist or the nurse will directly benefit the patient. When a parent or guardian is reluctant or intentionally does not want to consent to treatment of their child, should also be taken in to consideration as the nurse or the physiologist’s proposed form of treatment is not actually essential to the patient’s welfare and may be carried without substantial risk (Carrol, 2012). It is also important, as the nurse of the physiologists decides to move ahead with the treatment, that they respect the wishes of parents to the child who may have with their own reasons, refused to consent. Perhaps they need time to gain a better understanding of the outcome of the treatment and that they have fears or other reason regarding the proposed treatment and care (Hirsh, 2010). It is always good to coerce in this case, as a last resort. Informed consent is currently widely recognized as a pillar for relationship between the patient and the health care professionals. It stresses on the rights of patients over their bodies to be knowledgeable about the treatment and it protects the health workers from legitimating. Informed consent is therefore an essential requirement in practice of health care both in ethical and legal aspects. Discussion in this essay will be focused on various perspectives of two healthcare professionals with regard to informed consent, a pediatric nurse and a pediatric physiotherapist. The importance of intercommunication among the health workers is also explored. Relevant international and national ethical frameworks which lead to ethical decision making in the practice are also inclusive. Legal and ethical matters in health care in consenting vulnerable patient cohorts also differ. How decision making is influenced by the social and spiritual factors The spiritual and social issues which influence the health workers’ values and beliefs in ethical decision making are identified. Professional ethics requires nurses and pediatrics’ not to invade the beliefs of patients who seek health care. Nurses or pediatrics’ should avoid spiritual interactions with their patients at first sight otherwise on may shun away. Research indicates that religious beliefs and spiritual practices of patients are powerful factors for many in coping with serious illnesses and in making ethical choices about their treatment options and in decisions about end-of-life care (Puchalski, 2001; McCormick et al., 2012). With this editorial, it explains how nurses or pediatrics should engage the spiritual beliefs of the patient after its understanding in helping the patient in the healing process. Research also has proven that social and spiritual beliefs are associated positively with better health and psychological wellbeing (Puchalski, 2001; Koenig, 2004; Pargament et al., 2004). Here the health workers should be aware of the common health belief factors in their practice because it will enable them to advice their patients. Though there are factors such as difference in beliefs between family and patient or patient and the physician, the family may have different views as opposed to the patient or physician. Decisions made by patients normally depend on what the society view or say or on the perspective of their spiritual facts. As a matter of fact on will rely on what he or she believes in (Baliner, 2012). moreover physicians should be able to comply with the patient’s decisions so long as is correct and acceptable, and also be discrete in what they say in reference to the patients’ religion. Lastly, practicing ethical normative frameworks which a health professional may appeal to while defending their position both individually or collaboratively on moral and ethical dilemmas faced in the practice are also mentioned (Moreno, 2012). Conclusion Looking at the ethical, social and legal issues with regard to informed consent of pediatrics, it leads to the identification of very important issues and challenges that pediatric nurse and physiologist will encounter as part of pediatric practice. This is because, as has been observed in the above discussion, there are two concepts which are needed. One is the parental permission and the child’s assent. In Australia, one will realize that in most cases, physiologists and nurses dealing with pediatrics have no choice but to seek legal and ethical obligation to obtain informed consent from the child’s parents so as to undertake the recommended medical interventions (Wear, 2004). This means that it is always important for the pediatric nurse or physiologist to seek the assent of the child when it is appropriate enough. This is especially true in cases where the child who will undergo treatment is a young adult or a child who has been assessed to have decision making capacity. In some circumstances the nurse or the physiologist may also seek legal assent in order to perform the medical procedure on the patient. It is also very important that the parent is taken through all the procedures that will be involved in treatment to ensure that they totally understand everything that is involved in the treatment process (Hardman, Moppett, & Aitkenhead, 2011). This will include the medical procedure, the number of days the child will take to heal and other alternative so that the parent will have at the end of the process, made an informed consent. Bibliography Baliner, J. (2012). Ethical Dilemmas in Genetics and Genetic Counseling: Principles through Case Scenarios. Oxford University Press; 1 edition. Berg, J. W., & Appelbaum, P. S. (2010). Informed Consent: Legal Theory and Clinical Practice. Oxford University Press; 2 edition. Brown, B. J. (2011). Informed Consent: The U.S. Medical Education System Explained. Informed Advising. Carrol, R. (2012). Risk Management Handbook for Health Care Organizations, 3 Volume Set. Jossey-Bass; 6 edition. Clarke, S., & Oakley, J. (2011). Informed Consent and Clinician Accountability: The Ethics of Report Cards on Surgeon Performance. Cambridge University Press; 1 edition. Glhan, S. (2010). Informed Consent: A Novel. David C. Cook; New edition. Grisso, T., & Appelbaum, P. S. (2010). Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals. Oxford University Press; 1 edition. Hardman, J. G., Moppett, I. K., & Aitkenhead, A. R. (2011). Consent, benefit, and risk in anaesthetic practice. Oxford University Press; 1 edition. Hirsh, R. (2010). Informed Consent. CreateSpace Independent Publishing Platform. Kim, S. Y. (2012). Evaluation of Capacity to Consent to Treatment and Research (Best Practicesin Forensic Mental Health Assessment). Oxford University Press; 2 edition. Lynch, J., Terry, L. M., Battersby, S., & Smith, C. J. (2010). Consent to Treatment (Medico-Legal Essentials). Radcliffe Publishing; 1 edition. Moreno, J. D. (2012). Undue Risk: Secret State Experiments on Humans. Routledge; 1st edition. Strife, E. (2011). Doctor patient Confidentiality. Oxford University Press; 1 edition. Read More