Question

The process of informed consent occurs when communication between a patient and physician results in the patient's authorization or agreement to undergo a specific medical intervention. In seeking a patient's informed consent (or the consent of the patient's surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:

1. Assess the patient's ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.
2. Present relevant information accurately and sensitively, in keeping with the patient's preferences for receiving medical information. The physician should include information about:
3. The diagnosis (when known)
4. The nature and purpose of recommended interventions
5. The burdens, risks, and expected benefits of all options, including forgoing treatment
6. Document the informed consent conversation and the patient's (or surrogate's) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.

In emergencies, when a decision must be made urgently, the patient is not able to participate in decision making, and the patient's surrogate is not available, physicians may initiate treatment without prior informed consent. In such situations, the physician should inform the patient/surrogate at the earliest opportunity and obtain consent for ongoing treatment in keeping with these guidelines.

DISCUSSION ASSIGNMENT: INFORMED CONSENT

It has been maintained that patients have a right to complete information about their conditions.

But...

1) What happens when the diagnosis reveals a genetic disorder that can have known harmful effects on their children?  

2) Should the spouse automatically be told about this result?

3) Should the children be told?

4) Do other relatives have the right to know this information?

3) Who is the "patient" in these situations? Is it the one who has been tested? Is it the one who will be affected if they don't have the information?

  

4) What guidelines do you think should guide healthcare providers when it comes to such information being disclosed?

5) What ethical principles are at play here?

Answer 1

Question 1

Solution

When a patient is at hereditary risk condition, the entire family seems to be affected. Communicating the health issues to the entire family is bit difficult as it depends on many factors. Further in order to help the patient and close family members, a nurse should carefully monitor the issues and avoid undue stress in the process of disclosing the information to the family members after having the consent from the patient and under the purvew of the ethical aspects or legal proceedings. In this regard, the main goal of a clinician is to help the patient and family members by clearly informing all the consequences and the health associated risks faced by their family members and offering assistance with respect to proper knowledge of the particular genetic disease condition.

Question 2

Solution

According to the privacy rule of HIPAA act 1996 (Health Insurance Portability and Accountability Act), the entire healthcare associates including physician, nursing personnel; paramedics must ensure the privacy related to health information including genetic information of a particular patient. A person's decision regarding not to disclose the risk of a genetic condition to their family members may pretence a dilemma for the health care professional owing to the ethical obligations to inform the condition and possible legal requirements to protect the patient's privacy. Although the potential risk for the family members could not be overlooked. Hence, in this kind of situation with proper consent from the patient, the condition should be disclosed to spouse if necessary and if the patient is not in condition to give consent, legal proceedings should be followed while informing the medical condition to any of their close family members.

Question 3

Solution

There are several concerns while informing the genetic condition to a child as there might be involvement of a potential psychological harm, lack of autonomy for a child deciding the genetic test or child’s ability to understand the full implication of the received information regarding the genetic disease. Hence, the parents should understand the proper time to make their child realize the exact condition of the genetic disease and possible risks associated with them.

Question 4

Solution

This specifically depends on the family relationship and how their family members are apt to discuss the health and illness. All the information must be disclosed to the family members only after getting the written consent from the patient. Although if the healthcare provider thinks that there might be some risk associated with the relatives of the patient, all the information could be disclosed under the purview of the legal and ethical aspects and simultaneously looked into the privacy of the individuals. Moreover in this aspect, family members are encouraged to consult with the clinician to know more about the disease, possible outcome and undue consequences if any.