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Hi, everyone.

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This week can get complex,

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just like with other
topics, materials this week.

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I'm meant to provide
the general principles

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and not how we should deal

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with specific instances of complex care.

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So with that, welcome to week 11.

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Let's start with consent.

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Consent refers to the act of
giving permission or agreement,

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or something in the context of healthcare.

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It refers to that mutual
agreement or understanding

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between individuals who engage

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in a type of health activity or treatment.

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Consent is essential part
of a healthy relationship,

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and healthy communication between

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the providers and the patients.

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It helps all parties understand

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and respect each others
wishes and boundaries.

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As a general rule, all
health treatments require

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a patient's consent.

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That consent should also be informed.

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Informed consent means the
process of obtaining permission

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from a patient after providing them

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with all the necessary information

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about the activity or the treatment.

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It's essentially an
aspect of ethical practice

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in many fields, not just healthcare.

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Informed consent is when you give

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all the important information

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about the activity or treatment.

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Its purpose, the risks and
benefits, alternative options,

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any potential consequences

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or side effects from the treatment.

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Patient's given this
opportunity to ask questions

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and clarify concerns before deciding

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whether or not to give their consent.

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Informed consent is
important 'cause it ensures

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that patients are fully aware
of what they're agreeing to,

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and that their decisions
are being made freely

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without coercion or manipulation.

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It allows patients to
make informed decisions

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about their own health and wellbeing.

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Now, you might be already thinking

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about emergency situations, right?

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In an emergency situation,
obtaining that informed consent

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may not always be possible,

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and the priority might be
for the life-saving treatment

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or intervention to start
as quick as possible.

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In such cases,

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we use this principle of implied consent.

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Implied consent refers to the assumption

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that the individual or
the patient would consent

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to the necessary medical treatment

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or intervention if they could,

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even though they're currently unavailable

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to provide that consent.

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So if a person is unconscious

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or in a state where they're
unable to communicate

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and there's immediate threat

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to their life or to health,

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medical professionals may
assume that the person

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would want life-saving
treatment and proceed without

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that explicit consent
we just talked about.

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Now, implied consent does not give

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a healthcare provider permission
to perform any procedure

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or intervention that
they think is necessary

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without consideration of
the patient's best interest.

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So there has to also be an
evaluation of what is needed

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for that life saving treatment
under the circumstances.

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It's important to note
the use of implied consent

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should be guided by, you know,
ethics, ethical principles

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and basic medical standards.

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And healthcare providers
should always aim to obtain

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that explicit consent rather than rely

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on any kind of implied consent.

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Basically, if you are saving
someone from a heart attack,

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you definitely should not take care

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of another issue you see
while performing surgery,

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unless it's also related
to that emergency.

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Here's where this gets even more complex.

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What if someone refuses to
consent? And that does happen.

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What if they refuse to consent
to life-saving treatment?

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That also happens.

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This can present pretty
complex dilemmas for providers.

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The principle for respect
for autonomy dictates

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that individuals have the
right to make those decisions

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about their own healthcare,

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even if those decisions are not really

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in their best interest.

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However, in situations
where a person's health

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or life is in immediate danger,

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healthcare professionals may need

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to intervene to save their life.

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So this can get really
complicated very fast

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in emergency situation.

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In general, healthcare
providers try to work

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with the patient to address concerns

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or fears they might have
about the treatment,

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they attempt to persuade
them the best they can

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and accept lifesaving treatment.

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They might also work with
patients' family members,

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or loved ones, those who
are immediately available

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to help facilitate a communication

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and help with that
decision-making process.

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Finally, what happens if a patient

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is maybe incompetent or impaired?

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So an incompetent or impaired patient

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might be someone who's not capable

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of making that healthcare decision,

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and that won't be fixed
in a short amount of time.

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Could be due to physical
or mental condition

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that impairs their ability to
process relevant information,

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weigh the risks and the benefits
of the treatment options,

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communicate their preferences.

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You know, can be because
of cognitive impairment,

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mental health issues, brain injury,

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can be related to substance use.

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And, you know, children
under 18, generally,

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are considered to be incompetent as well.

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So they're not usually able

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to make autonomous decisions
about their healthcare,

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not all the time, right?

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This is a nuanced area.

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So how do we proceed in those situations?

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If someone is incompetent or impaired,

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what happens to that
informed consent process?

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What about implied consent?
How does that factor in?

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Sometimes there needs to be an
authorized surrogate, right?

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Might be a guardian, might
be a family member, you know,

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often in healthcare settings
you think of spouses

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or partners being able to make decisions,

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but there can also be court
appointed representatives

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to make decisions,

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or maybe the court will make the decision.

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These surrogates and
surrogate decision-makers

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are responsible for making

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that decision for the patient,

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but it still has to be
in the best interest

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of the patient based
on their understanding

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of what the patient's values,
preferences are, were.

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Healthcare providers still
have a ethical obligation,

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even with a substituted decision-maker,

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to respect the autonomy

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of the incompetent patients
wishes that they know

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or can find out to the
extent that it's possible.

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They also have a responsibility to ensure

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that surrogates make
decisions that are consistent

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with ethics, with those
patient values and preferences,

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and that they're acting in
patient's best interest.

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So this is multiple
layers of complication.

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You'll see a couple of examples
in the module this week.

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Just keep in mind that these
situations are all different,

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and they require different
levels of analysis.

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They're in different places,

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and different states have different

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ways of dealing with them.

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So you can't really use a
one size fits all mentality

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with these type of complex
consent situations.

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None of this is simple.

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Often many professionals get
involved in these situations,

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it's not just doctors or nurses,

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can involve lawyers and
psychologists and psychiatrists,

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hospital management.

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So this week is simply about how we start

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to think about these
really complex situations

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that involve consent, or the lack thereof.

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I'll see you in the discussion forum.