...Lesson 3 – Informed Consent, Substitute Decision-Making, and the Family Centered Approach * It should be noted that a choice might properly require only low/ minimal competence, even though its expected risks exceed its expected benefits or it is more generally a high-risk treatment, because all other available alternatives have substantially worse risk/benefit ratios. * Thus, according to the concept of competence endorsed here, a particular individual’s decision-making capacity at a given time may be sufficient for making a decision to refuse a diagnostic procedure when forgoing the procedure does not carry a significant risk, although it would not necessarily be sufficient for refusing a surgical procedure that would correct a life-threatening condition * The greater the risk relative to other alternatives—where risk is a function of the severity of the expected harm and the probability of its occurrence—the greater the level of communication, understanding, and reasoning skills required for competence to make that decision. * It is not always true, however, that if a person is competent to make one decision, then he or she is competent to make another decision so long as it involves equal risk. * Even if the risk is the same, one decision may be more complex, and hence require a higher level of capacity for understanding options and reasoning about consequences. * The evaluation of the patient’s decision-making will seek to assess how well...
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...• Analyze the legal issues related to informed consent and refusal Informed consent is an essential part of the treatment process in psychology. Legally it protects both the psychologist and the individual who will be receiving professional services. According to Pope and Vasquez (2007), informed consent provides the client and the therapist the opportunity to understand his or her legal rights and that they each have an equal vested interest in the treatment process. Pope and Vasquez (2007) also stated that informed consent is a decision making-process that gives the client the... The informed consent is the agreement between two parties to work collaboratively (Pope & Vasquez, 2007). In psychology, the client signs the consent form to allow treatment from the psychologist who may include testing, treatment, and initial psychological assessment. The patients have the right to their information; in terms of benefits, alternative treatments and about the risks. If the patient does not understand what he or she is giving permission to, he or she can allow an authorized decision-maker. The law requires that all persons take reasonable steps to clarify and communicate adequately with their patients about their risks and benefits. The informed consent is basically the understanding and justification of power that should not be abused intentionally or accidentally (Pope & Vasquez, 2007). The informed refusal is when a patient is refusing care; because of legal issues, trust, infectious...
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...My law and ethics understanding and beliefs In 1847 the American Medical Association revolutionized medicine in the United States. Members of this newly formed organization, met in Philadelphia as the first national professional medical organization in the world, dedicated themselves to establishing uniform standards for professional education, training, and conduct. They unanimously adopted the world's first national code of professional ethics in medicine. For more than 160 years since, the AMA's Code of Medical Ethics has been the authoritative ethics guide for practicing physicians. Ethics in Hand are pocket-sized guides to the Code of Medical Ethics for physicians and medical students. The Code articulates the enduring values of medicine as a profession. As a statement of the values to which physicians commit themselves individually and collectively, the Code is a touchstone for medicine as a professional community. It defines medicine’s integrity and the source of the profession’s authority to self-regulate. At the same time, the Code of Medical Ethics is a living document, evolving as changes in medicine and the delivery of health care raise new questions about how the profession's core values apply in physicians' day to day practice. The Code links theory and practice, ethical principles and real world dilemmas in the care of patients. The next time you hear a monotheist tell a non-believer that morals come from the Bible or that moral reasoning cannot provide an...
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...the importance of informed consent in research. Most people have the expectation that they will be treated with respect and as autonomous individuals. They also expect that they have the right to make decisions about what will and will not be done to them and about what personal information they will share with others. However, researchers also are aware that there are circumstances in which obtaining and documenting consent in social and behavioral research may be a complex, and often challenging process. For instance, potential subjects may be fluent in a language but not literate. Researchers may need to deceive research subjects in order obtain scientifically valid data. Asking subjects to sign consent forms linking them to a study about illegal activities could put them at risk of harm. The federal regulations provide sufficient flexibility to address some of these concerns, particularly for research posing no more than minimal risk of harm. For example, the regulations allow waivers of and alterations in the requirements for the consent and documentation processes. Learning Objectives By the end of this module you should be able to: • Distinguish between consent as a process and the documentation of consent. • Recognize the elements of consent. • Determine when waivers are appropriate. • Identify methods for ensuring comprehension of consent. Overview of Informed Consent Federal regulations require researchers to obtain legally effective informed consent from the...
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...Confidentiality and Informed Consent Claudia Lewis PSY/305 6/29/15 Dr. Daniel Williams Jr, PsyD, MSW Confidentiality and Informed Consent Introduction Dear client this paper is to inform you, of your right to confidentiality, and further more explain the process of informed consent. In the world of Psychology and counseling, confidentiality and informed consent has been the cornerstone to our practices (University of Phoenix, 1994). This paper will help you to understand how the things you say during the counseling sessions may have legal implications against you; by first explaining the decision of Tarasoff v. the board of Regents of the University of California, followed by how it relates to the therapist-client relationship in regards to confidentiality; then finally explaining the process of informed consent and refusal. Tarasoff v. Board of Regents of the University of California Decision According to University of Phoenix Confidentiality after Tarasoff (1994), the Tarasoff v. board of regents of the University of California case was heard before the California Supreme court, when Tatiana Tarasoff, a student at The University of California was killed by a fellow student. Her parents sued the University of California, the Police and the Therapist (University of Phoenix, 1994). The parents claim was that neither the School, Police or the Therapist warned them of the intentions of this fellow school mate to kill their daughter, Tatiana Tarasoff, as the fellow...
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...There are many serious issues for families to consider when faced with the prospect of removing life support for a loved one. My objective is to identify the key medical ethical considerations that are faced when considering the removal of life support for a patient. Then, I will draw some conclusions about the choices I would make if faced with the decision of having to remove life support for a member of my family. It may be that the decision to withhold or withdraw life support is most likely to pit the hopes and fears of patients and their families against medical science and their physician. Patients are compelled by powerful emotions (such as guilt) or by adherence to religious or secular traditions to behave in certain ways that may conflict with medical advice.2 Honest discussions with patients and their families about the benefits and burdens of therapy and the medical uncertainty that exists are necessary to provide patients and families with the best opportunity to make informed decisions. We know that honest direct communication is most important for patients and families faced to make life determining decisions. These health care workers must communicate within the medical ethics of their profession. Medical ethics is based on a four prima facie moral principles and attention to these principles' scope of application. The four prima facie principles are respect for autonomy, beneficence, non-maleficence, and justice. “Prima facie,” a term introduced by the English...
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...| |Was the significance of the study adequately described? |1. The significance of the study was adequately described. | | |Family presence (FP) during resuscitation is a matter that | |Was the purpose of the study clearly described? |warrants more investigation as to whether or not it should, or | | |should not be allowed. Furthermore, the study proposes the | |Were the interpretations presented in a descriptive way that |necessity of protocols in place in institutions to guide | |illuminated more than the quotes did? |decisions on this matter. | | | | | |2. The purpose of the study is clearly described as to explore | | |the beliefs and experiences of RNs about FP during CPR. | |...
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...The words “informed consent” gives an understanding to what it is. As a professional it is our duty to inform the individuals we are serving of what is happening and what could happen. First, we must understand the why. Informed consent is an important concept that can be seen when looking back through history. It is a safe guard that protects both the professional and the individual that is receiving the service or treatment. Second, we have to understand the “what” and the “who”. When presenting the information that needs consent we have to fully understand what the information is that we are trying to communicate to the individual. So that we can explain in away the individual can understand. The individual must be given the full...
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...be found in Doc Sharing. Title: RRL#2 Name: [replace this text with your name] The following questions pertain to: Sanford, J., Townsend-Rocchicciolli,J.,Horigan, A., & Hall, P. (2011). A process of decision making by caregivers of family members with heart failure. Research & Theory for Nursing Practice, 25(1), 55-70. 1) Describe the population for this study. The population that this study utilized was caregivers who took care of family members who had HF in the Southeastern part of the U.S. 2) How was the sample selected? What are the strengths and weaknesses of this sampling strategy? The sample was recruited from adult day care facilities, cardiology offices, and inpatient hopitals. The strength of this sample was the amount of variation it included, which accounted for caregivers from each of the four stageso f HF, and spanned a variety of nationalities, employment statuses, and genders. The only weakness in th sampling strategy was that there were only 20 participants. 3) Were the subjects in this study vulnerable? Were there any risks for them as the result of participation in the research study? The caregivers interviewed in the study were not vulnerable at all They simply explained their experiences regarding their process of decision making in the comfort of their own homes. The only potential risk was possibly causing emotional trauma by having caregivers discuss various ramifications of this condition...
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...| Informed Consent in Emergency Situations | By | | Liz Marotz | 3/1/2016 | | I. Introduction A. Explanation of an Informed Consent B. Type of Informed Consent C. How to use an Informed Consent in Emergency Situations II. Elements of Full informed consent A. Assessment of patient understanding B. The Nature of the decision/Procedure III. Interventions that require Informed Consent A. Cancer Screening test B. Clinical Decision IV. Waive Informed Consent Form A. Reason to waive B. Who gives the approval of waiver V. Conclusion A. Summary Informed consent means that permission is granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. However, informed consent in an emergency situation can only be presumed rather than obtained when the patient is unconscious or incompetent and no surrogate decision maker is available and the emergency interventions will prevent death or disability. In general, the patient's presence in the hospital ward, ICU or clinic does not represent implied consent to all treatment and procedures. The patient's wishes and values may be quite different from the values of the physician. While the principle of respect for the patient obligates the physician to do their best to include the patient in the health care decisions that affect the patient’s life and body, the principle...
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... 1.1 Non-Discrimination. Marriage and family therapists provide professional assistance to persons without discrimination on the basis of race, age, ethnicity, socioeconomic status, disability, gender, health status, religion, national origin, sexual orientation, gender identity or relationship status. 1.2 Informed Consent. Marriage and family therapists obtain appropriate informed consent to therapy or related procedures and use language that is reasonably understandable to clients. The content of informed consent may vary depending upon the client and treatment plan; however, informed consent generally necessitates that the client: (a) has the capacity to consent; (b) has been adequately informed of significant information concerning treatment processes and procedures; (c) has been adequately informed of potential risks and benefits of treatments for which generally recognized standards do not yet exist; (d) has freely and without undue influence expressed consent; and (e) has provided consent that is appropriately documented. When persons, due to age or mental status, are legally incapable of giving informed consent, marriage and family therapists obtain informed permission from a legally authorized person, if such substitute consent is legally permissible. 1.3 Multiple Relationships. Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore...
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...made about the strengths and weaknesses of the different parts, as well as of the whole, Burns (2000). Reflection follows on from this by encouraging the analysis of clinical practice, this in turn, helps the healthcare professional to develop his/her knowledge and to acquire a deeper level of understanding about the complexities of nursing practice. Boud et al (1985) suggests that this type of learning contributes to the development of clinical competence. The critical incident is taken from my recent clinical practice within the Endoscopy Unit. I will be reflecting upon and critically analysing gaining informed consent prior to the patient’s emergency Endoscopy and when to act within patient’s best interests. My rational for the chosen clinical incident is because of the impact it had on me. I realised I was not fully informed on the process of obtaining informed...
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...Which of the following is the most appropriate action to take for the investigator? Your answer : The investigator can go ahead and enroll the man without a signed consent. Correct Answer : Send a copy of the informed consent via facsimile to the subject's wife. After she has had the opportunity to speak to the investigator, she can sign the informed consent and fax it back. Comment : The IRB will not provide a waiver of consent under these circumstances and the man should not be excluded from the study simply because his legally authorized representative is temporarily unavailable to sign in person. Verbal approval does not satisfy the FDA requirement at 21 CFR 56.109(c) of signed informed consent document. When obtaining consent from a legally authorized representative (LAR) who is not able to provide signed consent in person, it is acceptable to send the informed consent document to the LAR by facsimile and conduct the consent interview by telephone when the LAR can read the consent as it is discussed as noted in the FDA's FAQs. If the LAR agrees, he/she can sign the consent and return the signed document to the clinical investigator by facsimile. Points Earned : 0 Question 2 Question : A general requirement for the informed consent is that no informed...
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...Informed consent Name Course Date Informed consent Informed consent is the procedure of getting permission to take part in a research study or medical procedure founded on access to all vital and easily understandable information about the consequences of participation in terms of benefits and harms (Dolgoff et al, 2009). A healthcare provider may demand informed consent from a patient before providing care or a researcher may request it from a participant before enrolling the individual into a research trial. Informed consent is based on guidelines provided by research and medical ethics. To give informed consent, the person involved must have sufficient reasoning faculties and have all the relevant facts. However, not all individuals may have capacities for informed consent due to impairments to reasoning and judgment such as mental immaturity, severe intellectual disabilities, mental illnesses, high stress levels, being in a coma, Alzheimer’s disease, and severe sleep deprivation. Medical and research actions may be carried out due to lack of informed consent. When a person is considered unable to give informed consent, another person can be authorized to give consent on behalf of that person (Manson & O'Neill, 2007). For instance, legal guardians or parents may give informed consent for young children and the mentally ill. In case a person is given insufficient information to make a reasoned decision, severe ethical issues may arise. In clinical trials...
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...models is the paternal model in which moral authority and discretion is assigned to the physician because of their competence, skill, and ability to keep the patient in good health. This model is seemingly corrupt because the autonomy of the patient is overlooked when the physician is in control. In a case where they physician and patient disagree about the meaning or a value that they each have, the patients values and understanding will not be taken into consideration. Paternalism is understood as a normative model, which tries to determine what is morally right and wrong with regard to human action. Though in some cases paternalistic action is needed sometimes especially in cases where the patient is not in a position to make their own decisions, i.e. their competence is ineffective, all paternalistic actions are not justifiable. Another model is the rational contractor model in which the relationship between physician and patient is based on the obligations of the doctor to perform in the best interest of the patient but where they have differing goals. Both...
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