Ethical Principles Underlying a Particular Aspect of the Informed Consent - Essay Example

Ethical Principles Underlying a Particular Aspect of the Informed Consent Introduction Informed Consent according to Brett, (1998), is the individual's willing agreement or refusal to undergo treatment. Awareness of the outcomes of the suggested action is given in a fully informed consent to patients in order for them to understand the possibility of reasonable risks, and for them to make a choice from all possible alternatives which are available to them. The information to an individual about a specific treatment is provided in the consent, it is up to the individual to accept or reject the treatment (Trudeau1993). Wallace, (1995) states that `` there are three elements form the basis of informed consent these are as follows. 1) that informed consent must be voluntary, 2) it must be specific and 3) it must come from a competent person such as adult with a sound mind. The patients must precisely what they are consenting to when the exact nature of the treatment has been determined.'' Informed consent is an ethical concept that has become an integral to contemporary medical ethics and medical practice, it ensures protection of patients against unwanted medical treatment, but it also makes possible of active involvement of the patient in her medical planning and care. Ethical requirement of informed consent must not conflict with over-all ethical obligations to a principle of beneficence of the physicians. Analysis Major Elements of Ethical Concept of Informed Consent There are two major elements of ethical concept of informed consent 1)comprehension, an ethical element in informed consent which includes awareness and understanding about the patient's situation and possibilities, given an adequate information about diagnosis, prognosis and alternative treatment choices and option of no treatment; and 2)free consent , an intentional and voluntary act in certain ways in which an individual freely authorizes a medical interventions in her life, the ability to choose among options and what may be recommended. Both elements constitute an important part of a patients self determination, which take hold of his own life and action and determining the meaning and possibility of what he undergoes as well as what she does (Informed Consent, 2004). Definition of Ethics and Medical Ethics Ethics is defined as a system of moral standards or values which are derived from numerous sources including religion, philosophy, law, institutions, professional codes, corporate mission statement, ethic committees, family, culture, friends, professional associates and personal experience. A subset of moral standards or values that medical practitioners, such as physicians, nurses, technicians, hospitals and even insurance companies, are using in the decision making process is called medical ethics. It encompasses medical professional associations and teachings. It plays an important role in defining acceptable and unacceptable behavior (Ethics in Clinical Practice, 2007). Ethical Dilemmas Healthcare professionals face difficult challenges, nowadays, in a rapid changing healthcare environment. They find it difficult to decide and choose what is best for their patients. Sometimes these choices concerns ethics and what the patient chooses may be different with the family or physician believes should be done. Each person may have values which are different from the others. It is difficult to decide if for instance the patient refuses life support, and the family wants everything done or what if the patient's family members wants life support and interventions stooped and the physician refuses to discontinue the therapy. In order face this issues health care professionals need specific tools to assist in this endeavor. To assist in resolving the ethical dilemma, ethical precepts and principles contained within the described ethical systems can help the nursing professional to conceptualize a problem-solving approach (Davis, AJ., 1978). Whether the decision making involves an individual facing end-of-life decisions or a society set ting healthcare policies, these ethical systems and principles are at the very root and assist the healthcare professional in making clear the blurred lines that can develop in bioethical and problematic situations. Informed Consent Principle Every individual has the right and responsibility to advance his or her own welfare, it is up to us if we will allow voluntary consent or refuse the consent of the recommended medical procedure, given by the physician, based on sufficient knowledge of the benefits, burdens, and risk involved in allowing the medical procedures that will be done to the patients. There are four requirements needed to be met in giving informed consent, 1) disclosure of information must be adequate, (these includes information concerning the diagnosis on the nature and purpose of treatment that will be given to the patient, risks of treatment and treatment alternatives). 2) the patient or one who will be given treatment must have the freedom to choose, 3) patient must easily comprehend the information of informed consent, 4) patients must have the capacity to decide. When these requirements are met three necessary conditions are satisfied, and these are as follows: 1) that the individual are given the chance to decide voluntarily. 2) that the patients decide with given appropriate understanding of the circumstances, and 3) considering all the given knowledge of all the expected benefits, burden, risks and reasonable alternatives given by the physicians, the choice of the patient must be deliberate (“The Principle of Informed Consent,” 2007). However there are disclosure exceptions, there are situations in which a physician does not have to disclose information for example in cases of emergency, therapeutic privilege, patient waiver and prior patient knowledge. In some cases, like for example in during emergencies, physicians do not have to disclose information. Only patients in stable condition are given disclosure information. The principle of therapeutic privilege is used when the disclosure of information could threaten the life of the patient or in certain cases that the patients have mental illness, however it cannot be used simply to push the patients into having the procedures. Patients have the right to waive the disclosure given by the physicians. Patients consent may be expressed in verbal or written or implied. A verbal consent is very difficult to prove that is why in most surgical procedures a written consent is required before doing the operations. Implied consent can be inferred, meaning an individual is willing to submit to the procedure. Implied consent can also be presumed if in some cases during emergencies such as life-threatening situations, like for example when the patient met an accident and it requires immediate attention to stop bleeding and when physicians knew that there is no reason to believe that the patients would refuse the treatment that would be given to him or her (Miller, 1986). The consent can be presumed, when the patient is in unconscious state and do not have the capacity to decide, and during special cases when the procedure is necessary and it cannot be postponed until the patient has regained his consciousness or decision-making capacity because the conditions could be detrimental to the patient. In some cases like when the surgeon sees that there is a critical need to perform an extensive surgical operation immediately and there is no time to contact the relatives of the patient, spouse, parents or surrogate of the unconscious patient, consent is also presumed. When the patient does not have the capacity to decide, his right and duty to give consent are exercised on his behalf by a surrogate, which is commonly known as vicarious consent, regulated by individual state and federal laws. Various standards of surrogate decision-making are followed, which includes subsequent judgment and best interest. Because of complexity of medical information, patients find it difficult to understand. Moreover physicians have limited time to communicate with the patients. To help the patients in fully understanding the procedures and the course of treatment that will be given to them, health professionals use various methods. They provide written information about the disease they use simple terminology in explaining the procedure and treatment that will be given. They simplify the complex medical terms to provide patients better understanding. In verifying patients, understanding of what they heard and read about their surgical procedures, the nurses use simple methods such as asking questions and letting the patients restate in their own words the information that the surgeon provided. Doing this would also help them enhance patient's memories and gives surgeons and nurses a chance to correct the misconceptions of the patient. Nurses use an interpreter, especially when the patient does not understand or cannot speak in English. To ensure that the patient really understood what is written in the consent the patients are given time to decide. The principles of Bioethics According to Van Rensselaer Potter II (1970), “Bioethics is used to describe a new philosophy that integrates biology, ecology, human values and medicine, meaning Biology combined with diverse humanistic knowledge forging a science that sets a system of medical and environmental priorities for acceptable survival.” Bioethics promotes the four (4) principle approach: Autonomy, Beneficence, Non-maleficence, and Justice. Each principle will be discussed in detail in the next paragraphs. Autonomy The principle of autonomy is based on the Principle of Respect for Persons: individuals have the right to make their own choices and be allowed to develop their own life plan (Garret, American College of Physicians Ethics Manual, 2,15). Autonomy is achieved and affirmed when all efforts are exerted to inform and discuss with the patient the medical options applicable to his medical condition. The patient's treatment preference is honored, and recorded in the patient's medical charts for documentation and future reference. In effect, this translates into informed consent. No treatment will be applied to the patient without his/her permission. If the patient is unable to make the decision, consent must come from his lawful surrogate (Garret,). Due to the complexity of the role in which the informed consent must make in behalf of the patient, the surrogate relative must be learned, competent and free from coercion or undue influence. He must be able to decide which of the options, is the best specific treatment (Beauchamp and Childress,). In no way must competence be measured the instance there is a conflict of preference between the health practitioner and the surrogate decision maker. Also, the fact that the patient has values different from the health care provider does not by itself prove the patient incompetent. Non-Maleficence It is anchored on the fundamental importance of considering the welfare of the patient, and not to inflict evil or harm to the patient. Te principle involved in non-maleficence is that the main responsibility of the physician is to take care of the patient’s health, making sure that they are given proper medication and not to do any harm on them. Physicians, according to excerpts of the work of Albert Jonsen entitled “Do No Harm”, “must do no harm on the patients, make sure that the patient must be provided with adequate care, they must properly assess the risks and benefits of the patients and make an assessment of the proper detriment-benefit of the patient.” Life of the patient may be harmed during a surgical operation, (that may be negligible) but it is only to prevent creating major harm such as death. The main purpose of doing this is save the patient. Beneficence The principle of beneficence is imbedded in the principle of benefiting others, doing good and acting with concern for that which will further the patient's interest. It is best understood when discussed with the Principle of Non-Maleficence. These two principles are perfectly illustrated in St. Thomas Aquinas' principle of morality: "Do good (beneficence) and avoid evil (non-maleficence)." When there is a conflict between the two principles, the principle of non-maleficence trumps the principle of beneficence. For example, if harvesting two good kidneys from an almost but not quite dead man helps two patients on dialysis, we should not harvest the organs since doing so would violate the principle of non-maleficence by harming the potential donor. Two good outcomes do not override the demand that we not harm patients (Beauchamp and Childress). Like doctors and nurses, psychologists possess this obligation to benefit their counselees, by safeguarding their welfare and rights. This is manifested in the provision of timely, effective and correct counsels to patients. Much effort is exerted therefore, in ensuring that psychologists' personal, financial, social, organizational, or political preferences are kept at bay, in the fulfillment of their functions, knowing that these may affect the lives of others, and possibly lead to the misuse of their influence. Justice This principle centers on the equitable distribution of medical goods and services, to consider contributing factors such as cost of supplies (expensive or cheap) and availability (scarcity or abundance). The formal application of this principle calls for the equal treatment of cases by health care practitioners and the society as well. For example, two patients with the same medical need not be treated differently (Beauchamp and Childress, 329). This principle, though crucial, does not tell us what we need or which needs are most important this depends on the internal judgment of the attending physician. Conclusion It is very important that the patient must be well informed before undergoing an operation and how to do it is a big challenge to all those who are responsible for caring for surgical patients. The role of perioperative nurses is extremely important. They are responsible for verifying surgical consent with patients and they are the ones responsible for making sure that the patients are well informed about what was the procedure that the patient will undergo. They offer opportunities to patients for further questioning to provide enlightenment to the patient, and to make sure that everything in the consent was understood before surgical operation procedure are done. It is indeed a challenging task for the nurses to assess the needs, and make sure that patients are given appropriate information. The approach given to every patient must be different because every individual is unique, patients may differ in personality, education, emotional condition, and capacity to understand the information that was given to them may be different. Some may have many questions and need further details about the information. Health care professionals must be willing to answer the questions and provide understanding for the patients about what surgical procedure and treatments that the patient would undergo and correct their misconceptions about the procedure. These four principles of bioethics serve as a framework in combining moral issues with medicine and the life sciences. Health practitioners will find these most useful, because, they are faced with the reality of being moral negotiators to moral strangers. These then, can be helpful guides in carrying out negotiations and conversations about treatment options. One of the advantages of this approach is its independence from any particular ethical theory. It can be applied to a variety of different traditions and reasons. Critics on the other hand, say that the principles are very general, with no clear prioritization. References Brett, SM. 1998, “Informed Consent-Ethics and the Elderly, '' British Journal of Theatre Nursing. 8(7). pp.21-27. Brazell, NE., 1997, “The Significance and Application of Informed Consent, '' AORN Journal, Association of Operating Room Nurses Inc. Feb. 1. Canadian Counselling Association: Code of Ethics. Davis, A.J. 1978. ``Ethical Dilemmas and Nursing Practice.'' New York: Appleton-Century-Crofts. Garret, Ethical Decission-Making. American College of Physicians Ethics Manual, 2, 15 Informed Consent, 2004, Washington DC: American College of Obstetricians and Gynecologists, Johnstone, M. 2004. Bioethics: a Nursing Perspective, 4th ed. Sydney, NSW: Churchill Livingstone. Miller, RD. 1986, Problems in Hospital Law, fifth ed. , Rockville , Md.: Aspen Publishers. ”The Principle of Informed Consent,” 2007, Ascension Health Wallace, M., 1995, Health Care and the Law, A Guide for Nurses, 2nd ed., Sydney: Law Book Corporation. Read More