Elements of Informed Consent – Case Study
Informed consent is the right of the patient to obtain sufficient and factual information from the physician or their representative. Based on this information, the patient can make an informed decision about the continuance of a particular treatment or procedure. Patients generally have a right of refusal to any of the medical care for reasons personal to them. The reasons may be religious or other personal grounds. It is mandatory that the healthcare provider attending on the patient and is reasonably involved with the healthcare of the patient to obtain the informed consent from the patient. However it is the prerogative of the attending physician to delegate the responsibility of obtaining the informed consent of the patient. The failure to obtain the informed consent entitles the patient the right to sue for medical malpractice. Informed consent becomes essential when the attending physician is going to touch the body of the patient or is commencing an invasive procedure. The informed consent may be express or implied. The information to be passed on to the patient for getting the informed consent must include,
- diagnosis of the disease or ailment,
- purpose for which the treatment or procedure is proposed,
- possible risks to which the patient may be exposed and the benefits that the patient can derive out of the treatment or procedure,
- possible alternative options with respect to the treatment or procedure and
- possible risks of not receiving the particular treatment or procedure (University of Virginia, 2001).
Consent of Mrs. Sparza
The consent obtained from Mrs. Sparza cannot be said to be an informed consent as it lacks in certain vital elements of informed consent. First, Mrs. Sparza was informed that surgery will be performed in both the eyes while she was under the impression that surgery would be performed in the right eye only. The diagnosis of operating on both the eyes should have been informed to her before she signs the general admission forms. She was informed of the procedure only in the operating room where she was supposed to sign the surgical consent form. This vitiates the essential requirement of an informed consent. Further, no detailed explanation of the purpose of the treatment and the potential risks and benefits of the treatment appear to be informed to Mrs. Sparza which is another requirement of informed consent. The conversation lasted for a minute and Mrs. Sparza was not left with any alternative options to pursue and was compelled to undergo the surgery. In view of these reasons the consent given by Mrs. Sparza cannot be considered as an informed consent.
End of Life Decision-Making
There are a number of cases decided by the courts on the question of end of life decision making. Some of which consider the decision as physician assisted suicide and some recognize the decision as a constitutional right of the patient. For instance in the New York State, there is the healthcare proxy law where end of life decisions are considered as living wills based on decided case laws. An ideal patient who is well informed about his/her disease and the treatment and procedure being followed would have a fair idea of the repercussions and suffering of the failure of such treatments or procedures. Patients have the right to give advance directives at the stage when they are still able to make decisions directing that in case the person becomes mentally incompetent, then he/she no longer is interested in receiving treatments or procedures which are futile and undertaken just to sustain the life. “These include cardiopulmonary resuscitation (CPR), respirators, and any other measures that the person cares to list”. (eMedicineHealth, 2009) In the case of Mrs. Sparza she had clearly indicated about her unwillingness to continue the treatments or procedures in case some unexpected developments take place in her health conditions. She gave this directive when she was active and was able to communicate her decision in this respect. Therefore her decision on end of her life is perfectly valid and has to be respected.
Legality of Administering Morphine
According to Washington law, physicians are allowed to minimize the pain by administering medicines that will hasten the death. However, the physicians have to administer such medicines only while withdrawing artificial life support to the patient. The physicians are at liberty to administer medicines to patients who are in terminal conditions with intent to ease the pain even when the medicines administered will have the effect of hastening the death. Another requirement for taking this extreme step is to get the consent of the patient with the understanding that the medicine will act to speed up the death. However there is a distinction in the legal standing of this point. A patient who refused medical treatment to sustain his/her life will die from the associated fatal conditions of the refusal. On the other hand injecting a lethal dose of medication would amount to killing the patient. The intent of a physician to remove the life-sustaining futile treatment may be in accordance with the wish of the patient; but, injecting lethal medication has an obvious intention of not easing the pain but causing the death of the patient. Therefore the administering of morphine by the nurse is not legal.
eMedicineHealth. (2009). End-of-Life Decision Making.
UniversityofVirginia. (2001). Elements of Medical Informed Consent. Web.