Hi, everyone.
This week can get complex,
just like with other topics, materials this week.
I'm meant to provide the general principles
and not how we should deal
with specific instances of complex care.
So with that, welcome to week 11.
Let's start with consent.
Consent refers to the act of giving permission or agreement,
or something in the context of healthcare.
It refers to that mutual agreement or understanding
between individuals who engage
in a type of health activity or treatment.
Consent is essential part of a healthy relationship,
and healthy communication between
the providers and the patients.
It helps all parties understand
and respect each others wishes and boundaries.
As a general rule, all health treatments require
a patient's consent.
That consent should also be informed.
Informed consent means the process of obtaining permission
from a patient after providing them
with all the necessary information
about the activity or the treatment.
It's essentially an aspect of ethical practice
in many fields, not just healthcare.
Informed consent is when you give
all the important information
about the activity or treatment.
Its purpose, the risks and benefits, alternative options,
any potential consequences
or side effects from the treatment.
Patient's given this opportunity to ask questions
and clarify concerns before deciding
whether or not to give their consent.
Informed consent is important 'cause it ensures
that patients are fully aware of what they're agreeing to,
and that their decisions are being made freely
without coercion or manipulation.
It allows patients to make informed decisions
about their own health and wellbeing.
Now, you might be already thinking
about emergency situations, right?
In an emergency situation, obtaining that informed consent
may not always be possible,
and the priority might be for the life-saving treatment
or intervention to start as quick as possible.
In such cases,
we use this principle of implied consent.
Implied consent refers to the assumption
that the individual or the patient would consent
to the necessary medical treatment
or intervention if they could,
even though they're currently unavailable
to provide that consent.
So if a person is unconscious
or in a state where they're unable to communicate
and there's immediate threat
to their life or to health,
medical professionals may assume that the person
would want life-saving treatment and proceed without
that explicit consent we just talked about.
Now, implied consent does not give
a healthcare provider permission to perform any procedure
or intervention that they think is necessary
without consideration of the patient's best interest.
So there has to also be an evaluation of what is needed
for that life saving treatment under the circumstances.
It's important to note the use of implied consent
should be guided by, you know, ethics, ethical principles
and basic medical standards.
And healthcare providers should always aim to obtain
that explicit consent rather than rely
on any kind of implied consent.
Basically, if you are saving someone from a heart attack,
you definitely should not take care
of another issue you see while performing surgery,
unless it's also related to that emergency.
Here's where this gets even more complex.
What if someone refuses to consent? And that does happen.
What if they refuse to consent to life-saving treatment?
That also happens.
This can present pretty complex dilemmas for providers.
The principle for respect for autonomy dictates
that individuals have the right to make those decisions
about their own healthcare,
even if those decisions are not really
in their best interest.
However, in situations where a person's health
or life is in immediate danger,
healthcare professionals may need
to intervene to save their life.
So this can get really complicated very fast
in emergency situation.
In general, healthcare providers try to work
with the patient to address concerns
or fears they might have about the treatment,
they attempt to persuade them the best they can
and accept lifesaving treatment.
They might also work with patients' family members,
or loved ones, those who are immediately available
to help facilitate a communication
and help with that decision-making process.
Finally, what happens if a patient
is maybe incompetent or impaired?
So an incompetent or impaired patient
might be someone who's not capable
of making that healthcare decision,
and that won't be fixed in a short amount of time.
Could be due to physical or mental condition
that impairs their ability to process relevant information,
weigh the risks and the benefits of the treatment options,
communicate their preferences.
You know, can be because of cognitive impairment,
mental health issues, brain injury,
can be related to substance use.
And, you know, children under 18, generally,
are considered to be incompetent as well.
So they're not usually able
to make autonomous decisions about their healthcare,
not all the time, right?
This is a nuanced area.
So how do we proceed in those situations?
If someone is incompetent or impaired,
what happens to that informed consent process?
What about implied consent? How does that factor in?
Sometimes there needs to be an authorized surrogate, right?
Might be a guardian, might be a family member, you know,
often in healthcare settings you think of spouses
or partners being able to make decisions,
but there can also be court appointed representatives
to make decisions,
or maybe the court will make the decision.
These surrogates and surrogate decision-makers
are responsible for making
that decision for the patient,
but it still has to be in the best interest
of the patient based on their understanding
of what the patient's values, preferences are, were.
Healthcare providers still have a ethical obligation,
even with a substituted decision-maker,
to respect the autonomy
of the incompetent patients wishes that they know
or can find out to the extent that it's possible.
They also have a responsibility to ensure
that surrogates make decisions that are consistent
with ethics, with those patient values and preferences,
and that they're acting in patient's best interest.
So this is multiple layers of complication.
You'll see a couple of examples in the module this week.
Just keep in mind that these situations are all different,
and they require different levels of analysis.
They're in different places,
and different states have different
ways of dealing with them.
So you can't really use a one size fits all mentality
with these type of complex consent situations.
None of this is simple.
Often many professionals get involved in these situations,
it's not just doctors or nurses,
can involve lawyers and psychologists and psychiatrists,
hospital management.
So this week is simply about how we start
to think about these really complex situations
that involve consent, or the lack thereof.
I'll see you in the discussion forum.