scholarly journals Anesthesiology Trainees Face Ethical, Practical, and Relational Challenges in Obtaining Informed Consent

2009 ◽  
Vol 110 (3) ◽  
pp. 480-486 ◽  
Author(s):  
David B. Waisel ◽  
Giulia Lamiani ◽  
Norma J. Sandrock ◽  
Robert Pascucci ◽  
Robert D. Truog ◽  
...  
Keyword(s):  
Informed Consent ◽  
Communication Skills ◽  
Key Words And Phrases ◽  
Ethical Challenges ◽  
Patient Decision Making ◽  
Patient Decision ◽  
Decision Making Capacity ◽  
Included Patient ◽  
Education Performance ◽  
Trainee Competence

Background Categorizing difficulties anesthesiologists have in obtaining informed consent may influence education, performance, and research. This study investigated the trainees' perspectives and educational needs through a qualitative analysis of narratives. Methods The Program to Enhance Relational and Communication Skills-Anesthesia used professional actors to teach communication skills and relational abilities associated with informed consent. Before attending the program, participants wrote about a challenging informed consent experience. Narratives were analyzed by two researchers following the principles of grounded theory. The researchers independently read the narratives and marked key words and phrases to identify reoccurring challenges described by anesthesiologists. Through rereading of the narratives and discussion, the two researchers reached consensus on the challenges that arose and calculated their frequency. Results Analysis of the 39 narratives led to the identification of three types of challenges facing anesthesiologists in obtaining informed consent. Ethical challenges included patient wishes not honored, conflict between patient and family wishes and medical judgment, patient decision-making capacity, and upholding professional standards. Practical challenges included the amount of information to provide, communication barriers, and time limitations. Relational challenges included questions about trainee competence, mistrust associated with previous negative experiences, and misunderstandings between physician and patient or family. Conclusions The ethical, practical, and relational challenges in obtaining informed consent colored trainees' views of patient care and affected their interactions with patients. Using participant narratives personalizes education and motivates participants. The richness of narratives may help anesthesiologists to appreciate the qualitative aspects of informed consent.

scholarly journals Converting the Informed Consent From a Perfunctory Process to an Evidence-Based Foundation for Patient Decision Making

2008 ◽  
Vol 1 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Suzanne V. Arnold ◽  
Carole Decker ◽  
Homaa Ahmad ◽  
Olawale Olabiyi ◽  
Surya Mundluru ◽  
...  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Evidence Based ◽  
Patient Decision Making ◽  
Patient Decision

Assessment of patient decision-making capacity in the context of voluntary euthanasia for psychic suffering caused by psychiatric disorders: a qualitative study of approaches among Belgian physicians

2020 ◽  
pp. medethics-2019-105690
Author(s):  
Frank Schweitser ◽  
Johan Stuy ◽  
Wim Distelmans ◽  
Adelheid Rigo
Keyword(s):  
Decision Making ◽  
Psychiatric Disorder ◽  
Cognitive Ability ◽  
Voluntary Euthanasia ◽  
Patient Decision Making ◽  
Patient Decision ◽  
Decision Making Capacity ◽  
Semistructured Interviews ◽  
Values And Beliefs ◽  
The Subject

ObjectiveIn Belgium, people with an incurable psychiatric disorder can file a request for euthanasia claiming unbearable psychic suffering. For the request to be accepted, it has to meet stringent legal criteria. One of the requirements is that the patient possesses decision-making capacity. The patient’s decision-making capacity is assessed by physicians.The objective of our study is to provide insight in the assessment of decision-making capacity in the context of euthanasia for patients with psychic suffering caused by a psychiatric disorder.MethodTwenty-two semistructured interviews with psychiatrists and neurologists were analysed with NVivo, a qualitative analysis software to code and organise transcribed data.ResultsDifferent views and approaches regarding decision-making capacity in the context of euthanasia emerged from the data.Most of the physicians have some knowledge of the cognitive ability approach on decision-making capacity. According to this approach, four abilities constitute decision-making capacity: communication, understanding, appreciation and reasoning. We observed differences in the way these abilities are valued in relation to competence. Some physicians take additional elements into consideration when assessing decision-making capacity.Physicians acquired their knowledge on the subject in many different ways. Most of the physicians reported that decision-making capacity was not part of their training.ConclusionWe conclude that physicians assess decision-making capacity in different ways and that personal values and beliefs influence their approach. As such, a common approach in assessing the decision-making capacity of a patient among the interviewed physicians is lacking. Less arbitrariness could be obtained by consistently implementing the cognitive ability approach.

scholarly journals Montgomery, informed consent and causation of harm: lessons from Australia or a uniquely English approach to patient autonomy?

2018 ◽  
Vol 44 (6) ◽  
pp. 384-388 ◽  
Author(s):  
Malcolm K Smith ◽  
Tracey Carver
Keyword(s):  
Informed Consent ◽  
Information Disclosure ◽  
Healthcare Providers ◽  
Health Board ◽  
Patient Decision Making ◽  
Rigorous Approach ◽  
Patient Decision ◽  
Uk Supreme Court ◽  
The Uk ◽  
Negligence Law

The UK Supreme Court in Montgomery v Lanarkshire Health Board adopts an approach to information disclosure in connection with clinical treatment that moves away from medical paternalism towards a more patient-centred approach. In doing so, it reinforces the protection afforded to informed consent and autonomous patient decision making under the law of negligence. However, some commentators have expressed a concern that the widening of the healthcare providers’ duty of disclosure may provide impetus, in future cases, for courts to adopt a more rigorous approach to the application of causation principles. The aim would be to limit liability but, in turn, it would also limit autonomy protection. Such a restrictive approach has recently been adopted in Australia as a result of the High Court decision in Wallace v Kam. This paper considers whether such an approach is likely under English negligence law and discusses case law from both jurisdictions in order to provide a point of comparison from which to scope the post-Montgomery future.

Sign in / Sign up

Export Citation Format

Share Document