Autonomy And Informed Consent Analysis

When a patient is unable to make decisions for himself or herself, their caregivers and those who know them are appointed to make the decisions based on what the patient would have wanted. This is called surrogate decision making. According to the article Terri Schiavo and End-of-Life Decisions “when surrogate decision makers and caregivers cannot agree upon what that choice would have been, they may turn to the courts to determine either what the now-incapacitated patient would have chosen or who is best suited to choose as the patient would have” (Mathes, 2005)

This information must be easy for the patient to understand and must also be correct and truthful (RCN 2013). The Department of Health define consent as allowing a capable individual to make their own decisions about their health care without being pressured into making any decisions from others such as friends, family and health care professionals. In the adult nursing field it is legal and ethical to gain valid consent before starting a medical procedure, or providing care. This shows that the individuals rights have been respected which is good practice. If a healthcare professional did not respect an individual’s choices they could be accountable to legal proceedings. In common law touching or performing an act of care on a patient without valid consent can be classed as a criminal offence or battery. If a healthcare professional was not following the legal practice regarding consent then the individual may be faced with a criminal offence and disciplinary action will take place (Dimond 2009). The Human Rights Act states that all healthcare professionals should never judge an individual on their sex, race, religion, social origin, language or any other status.

Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’. However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment.” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy. According to Sule, “This is another ethical issue erupting from the conflict of patient's rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient's health and treatment.” This can cause conflicting issues in the NP’s

Consent should be obtained before carrying out any form of care or activity with any individual; if consent cannot be obtained then any form of care etc should not be carried out. If consent cannot be readily established and patient presents in an emergency situation, is unconscious, mentally incapable, and with no family available, and no advanced directive in place, it is considered reasonable to treat the patient. It is assumed that under these conditions, the patient would consent to treat. If there is a language barrier, and the patient is otherwise capable of giving consent, a reasonable effort must be made to find an interpreter, which includes using the ones through the phone companies. If the patient's life is in danger, and there is nobody who can communicate with them, then with careful documentation, treatment can be delivered.

If an emergency is life-threatening, or the patient is not mentally competent to make a decision regarding consent, then the requirement may be waived. In a life-threatening situation, there may not be time to provide a patient with the risks and benefits of a procedure. If a surrogate is available to make a decision on behalf of the patient, such as a spouse or a parent, then they will often to be authorized to give consent. Otherwise, informed consent is presumed.

In this case, the night of January 11, 1983, Nancy Cruzan was driving a car and lost control of her car as she traveled down Elm Road in Jasper County, Missouri. The car overturned, and Nancy Cruzan was discovered lying face down in a ditch without detectable respiratory and cardiac function. Paramedics were able to restore her breathing and heartbeat at the accident site and she was transported to a hospital in an unconscious state. Then neurosurgeon diagnosed her and found that she is having sustained probable cerebral contusions compounded by significant anoxia (lack of oxygen). The Missouri trial court found that permanent brain damage generally results after 6 minutes in an anoxic state and Nancy was in this stage for 12 to 14 minutes.

Every seriously ill patient and their family should have decided the following issues: proxy, resuscitation, hospitalization, and specific treatments. Every seriously ill person needs to have pointed out a person to speak on their behalf when they get too sick to do so. A “proxy” can be filled out at any hospital or nursing home granting “power of attorney” to a loved one to be able to make decisions. A person

According to According to (Gerald, Corey, Schneider, & Callanan, 2015) “Informed consent involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it” (p.154). Section B of the ASCA National standards for School Counselors states “Recognize that providing services to minors in a school setting requires school counselors to collaborate with students’ parents/ guardians as appropriate” (pg.6). Since I will be working in the school system. I have to be aware that parents and guardians are heavily involved with the student’s school counseling experience.

Apart from this, The Illinois General Assembly in 1991 passed the Illinois Health Care Surrogate Act which applies to all medical treatment decisions. “The Act provides standards for making decisions about treatment for individuals who lack decision-making capacity and who and have not executed a durable power of attorney for health care or a living will”( www.isms.org). In such cases the act allows family members, friends or guardians to act as a Healthcare surrogate. The health care surrogate in consultation with the attending physician can make medical treatment decisions on behalf of a minor or an adult patient who lacks decisional capacity. According to the law, the order of priority in determining the surrogate decision maker is the patient’s guardian, followed by the patient’s spouse, any adult child, parents, adult sibling, adult grandchild, and lastly a close friend.

Consent can be quite tricky, a legal minefield for healthcare teams, this is due to the patients who will give or refuse to give private information about themselves who is legally competent but

The case of J, the 17 year old who needed a below the elbow amputation is a classic example of a case for the emergency exception to the need for consent. In this case, the three conditions justifying treatment without informed consent were present. The patient was unconscious therefore incapable of consenting with no lawful surrogate available, there was danger of significant impairment to health, and immediate treatment was necessary to prevent these complications. The need for treatment was urgent enough that delaying it to get in contact with the surrogate would endanger the patient. Additionally, the physician obtained a clinical consultation from two other physicians and confirmed the need for immediate amputation. Typically, no one raises

As an administrator I would need to take into consideration the patient’s autonomy, autonomy is recognizing an individual’s right to make his/her own decisions about what is best for them regarding their health care (Pozgar, 2012). The patient’s rights always should be considered before any decisions are made by any other family members. In this scenario it is clear that the patient is unable to make any decisions, the patient has suffered a serious brain damage, and although it is not complete brain death, we must determine how to proceed.

As a doctor, to prepare myself to take on this case I would have to process a substantial amount of information and use my best judgment to conceive what the best plan of action regarding this case should be. Reviewing the four key principles in medical ethics: nonmaleficience, beneficence, respect for autonomy, and justice, would prove to be very helpful. After reviewing and consulting with my peers I would most likely conclude that the patient is the one receiving the service and is to be put first above all other factors contributing to the situation.

Autonomy applies to the profession of nursing because the patient should always be allowed to make decisions regarding their care while being treated with respect and dignity; however, autonomy can serve as a limiting agent when the patient decides to refuse care that would be of benefit to them. Autonomy is a sensitive issue because it allows the patient to choose to die and all health care can do from that point is allow the patient to do so comfortably. With healthcare always being one step ahead, it allows a surrogate to serve as a voice piece for that patient when they are unable to make decisions. However, that surrogate can end up making decisions they think is best for the patient ignoring the patients’ will. The responsibility of the nurse and interdisciplinary team is to inform and educate the patient and patient’s surrogate on all aspects of care to include medical diagnosis, treatment, and care plan so that the patient and

The autonomy of a competent patient is an issue not often debated in medical ethics. Refusal of unwanted treatment is a basic right, likened to the common law of battery, available to all people capable of a competent choice. These fundamental rules of medical ethics entered a completely new forum as medical technology developed highly effective life-sustaining care during the 20th century. Several watershed cases elucidated these emerging issues in the 1960’s and 70’s, none more effectively than that of Karen Ann Quinlan. Fundamentally, this case established that a once-competent patient without the possibility of recovery could have their autonomy exercised by a surrogate in regard to the