Does radiology require informed consent for radiation risk?

2021 ◽  
pp. 20210620
Author(s):  
Elizabeth M Davies ◽  
Andrew J Bridges ◽  
Emma ML Chung
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Decision Making ◽  
Radiation Risk ◽  
Ethical Framework ◽  
Medical Decision ◽  
Shared Decision ◽  
Patient Relations ◽  
Recent Trends ◽  
Doctor Patient Relations

Recent trends in medical decision-making have moved from paternalistic doctor-patient relations to shared decision-making. Informed consent is fundamental to this process and to ensuring patients’ ongoing trust in the health-care profession. It cannot be assumed that patients consent to the risk associated with medical exposures, unless they have been provided with the information to make that decision. This position is supported by both the legal and ethical framework around Radiation Protection detailed in this commentary.

Informed Consent and Advance Directives

2004 ◽  
Vol 94 (2) ◽  
pp. 198-205
Author(s):  
Jay M. Baruch
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
End Of Life ◽  
Advance Directives ◽  
Medical Decision Making ◽  
Informed Decision ◽  
Ethical Framework ◽  
Medical Decision ◽  
Informed Decision Making ◽  
Popular Belief

Contrary to popular belief, a patient’s signature on a piece of paper does not constitute informed consent. This article describes the ethical framework of consent in the context of the larger process of informed decision making. The elements of informed consent are examined in practical terms. Common pitfalls are addressed, with strategies to help anticipate and resolve possible dilemmas. These important tools are integral to all levels of medical decision making, including those at the end of life. (J Am Podiatr Med Assoc 94(2): 198-205, 2004)

scholarly journals Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition

2016 ◽  
Vol 27 (7) ◽  
pp. 1035-1048 ◽  
Author(s):  
Katherine D. Lippa ◽  
Markus A. Feufel ◽  
F. Eric Robinson ◽  
Valerie L. Shalin
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Distributed Cognition ◽  
Medical Decision Making ◽  
Medical Training ◽  
Adverse Outcomes ◽  
Medical Decision ◽  
Shared Decision ◽  
Access To Information ◽  
Decision Space

Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.

scholarly journals 41st Annual North American Meeting of the Society for Medical Decision Making; October 21, 2019; Portland, Oregon Keynote Address The More Who Die, the Less We Care: Confronting the Deadly Arithmetic of Compassion

2020 ◽  
Vol 5 (1) ◽  
pp. 238146832091431
Author(s):  
Paul Slovic
Keyword(s):  
Decision Making ◽  
North American ◽  
Medical Decision Making ◽  
Human Life ◽  
Cost Effective ◽  
Medical Decision ◽  
Keynote Address ◽  
Shared Decision ◽  
Daily Lives ◽  
The Face

In this keynote address delivered at the 41st Annual North American Meeting of the Society for Medical Decision Making, I discuss the psychology behind valuing human lives. Research confirms what we experience in our daily lives. We are inconsistent and sometimes incoherent in our valuation of human life. We value individual lives greatly, but these lives lose their value when they become part of a larger crisis. As a result, we do too little to protect human lives in the face of catastrophic threats from violence, natural disasters, and other causes. In medicine, this may pose difficult choices when treating individual patients with expensive therapies that keep hope alive but are not cost-effective for the population, for example, with end of life. Lifesaving judgments and decisions are highly context-dependent, subject to many forms of response mode and framing effects and affective biases. This has implications for risk communication and the concept of shared decision making. Slower, more introspective decision making may reduce some of the biases associated with fast, intuitive decisions. But slow thinking can also introduce serious biases. Understanding the strengths and weaknesses of fast and slow thinking is a necessary first step toward valuing lives humanely and improving decisions.

scholarly journals Institutional constraints on strategic maneuvering in shared medical decision-making

2012 ◽  
Vol 1 (1) ◽  
pp. 19-32 ◽  
Author(s):  
A. Francisca Snoeck Henkemans ◽  
Dima Mohammed
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Decision Making ◽  
Critical Discussion ◽  
Medical Decision ◽  
Institutional Constraints ◽  
Treatment Preferences ◽  
Shared Decision ◽  
Basic Principles ◽  
The Ideal

In this paper it is first investigated to what extent the institutional goal and basic principles of shared decision making are compatible with the aim and rules for critical discussion. Next, some techniques that doctors may use to present their own treatment preferences strategically in a shared decision making process are discussed and evaluated both from the perspective of the ideal of shared decision making and from that of critical discussion.

Patient attendance at molecular tumor board: A new means of shared decision making?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18001-e18001
Author(s):  
Timothy Lewis Cannon ◽  
Donald L. Trump ◽  
Laura Knopp ◽  
Hongkun Wang ◽  
Tiffani DeMarco ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Tumor Board ◽  
Shared Decision ◽  
Treatment Team ◽  
Level Of Satisfaction ◽  
Holistic Method ◽  
Molecular Tumor Board

e18001 Background: Patient engagement in medical decision-making improves patient related outcomes through compliance and patient satisfaction. The Inova Schar Cancer Institute (ISCI) has a weekly molecular tumor board (MTB) to match comprehensive genomic sequencing results with targeted therapies for patients. The ISCI MTB invites patients to attend and engage in the MTB discussion. We performed a pilot study to investigate the feasibility and satisfaction in patients who attended MTB. Methods: During the time of this study, August 2017 through October 2018, 139 patients were presented and all 20 who were able to attend MTB completed pre-and post- MTB surveys. Patients who did not attend were either not invited by their primary oncologist, unable to attend, or chose not to attend. The survey included six questions related to comprehension, engagement, and satisfaction with the treatment team. Results: There was a statistically significant change for the question “I am satisfied with how well informed I am about targeted therapy” with p = 0.016. All 20 patients answered positively that it was beneficial for them to attend. Many patients expressed concerns about their difficulty understanding the technical aspects of the meeting. Conclusions: Patients who attended MTB reported a higher level of satisfaction after MTB attendance as compared to before MTB. This may reflect a sense of engagement in shared decision making rather than comprehension of genomic information. A more holistic method of studying this practice would include sampling a larger patient population and a formal evaluation of the physicians’ experience with patients attending. Supported by philanthropic funds from the Inova Schar Cancer Institute.

Informed Consent and the Nurse

1981 ◽  
Vol 2 (2) ◽  
pp. 1-8 ◽  
Author(s):  
Angela R. Holder ◽  
John W. Lewis
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Health Professionals ◽  
Medical Decision Making ◽  
Social Economic ◽  
Legal Responsibility ◽  
Medical Decision ◽  
Right To Know ◽  
Personal Factors ◽  
Value Judgments

Informed consent, as the courts define it, is the patient's right to know, before agreeing to a procedure, what the procedure entails — the hazards, the possible complications, and expected results of the treatment. The patient must understand any reasonable alternatives to the proposed procedure, including, in most cases, the results that can be predicted from nontreatment. The choice among alternative risks involves value judgments falling outside the scope of medical decision-making, including the patient's views on social, economic, and other personal factors of which health professionals cannot possibly be aware.The negotiations necessary to obtain the patient's informed consent are the responsibility of the person who will perform the procedure. If a physician is in charge, the physician may delegate the discussion to another but retains the legal responsibility to make sure the patient understands.

Exceptions to the Legal Requirements: Emergency, Waiver, Therapeutic Privilege, and Compulsory Treatment

2001 ◽  
Author(s):  
Jessica W. Berg ◽  
Paul S. Appelbaum ◽  
Charles W. Lidz ◽  
Lisa S. Parker
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Consent To Treatment ◽  
Health Related ◽  
Consent Requirement ◽  
The Right ◽  
Therapeutic Privilege

In the preceding chapter we spoke of the requirement for informed consent in absolute terms, as something that was an invariable component of medical decision making. Over the years, courts have come to recognize that there are a number of situations in which physicians are permitted to render treatment without patients’ informed consent. Even under the earlier simple consent requirement, consent to treatment was not required in all situations. There are different kinds of situations in which requiring disclosure and obtaining consent could be detrimental to the patient, such as in an emergency or when the disclosure itself would harm the patient, and therefore in these situations informed consent is not required. Patients may also waive, or give up, the right to be informed and/or to consent. Here the concern is not with promoting health values but with promoting autonomy. Informed consent may also be dispensed with in a fourth set of cases, those of legally required treatment, in which the harm from requiring informed consent is not necessarily to the patient (or the patient alone) but to other important societal interests (e.g., civil commitment of the dangerous mentally ill—see Chapter 11—or forced treatment of patients with infectious disease). In addition, informed consent requirements are modified when a patient is incompetent (see Chapter 5). Each of these exceptions contains the potential for undermining the values sought to be implemented by the informed consent doctrine: self-determination and informed decision making. Exceptions that are too broadly defined and applied are a threat to these values. On the other hand, these exceptions are an important vehicle for the interjection into the decisionmaking process of another set of values, society’s interest in promoting the health of individuals. When judiciously defined and applied, the exceptions accord health-related values their due. However, the exceptions can be, and sometimes have been, defined so broadly as to dilute, if not dissolve, the fundamental duties imposed by the doctrine and to undermine its essential purpose of assuring patient participation in medical decision making (1).

scholarly journals Medical Decision-Making Capacity

GeroPsych ◽  
2018 ◽  
Vol 31 (2) ◽  
pp. 57-65 ◽  
Author(s):  
Dragutin Novosel ◽  
Stjepan Ljudevit Marušić ◽  
Nikola Biller-Andorno ◽  
Manuel Trachsel
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
General Practitioners ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Medical Treatments ◽  
Decision Making Capacity ◽  
Legal Perspective ◽  
Almost All ◽  
And Training

Abstract. Decision-making capacity (DMC) is a prerequisite for informed consent to medical treatments. However, little is known about the knowledge, attitudes, and evaluation of DMC among physicians in Croatia. A survey was conducted among 180 general practitioners and psychiatrists in Croatia. Although from a legal perspective DMC is a dichotomous concept, about 90% of physicians indicated that they understand DMC to be a gradual concept. A majority of physicians considered themselves responsible and qualified to conduct DMC evaluations, though some physicians considered themselves insufficiently qualified. General practitioners considered themselves less responsible and less qualified than psychiatrists. Almost all participants indicated that they would welcome official guidelines and training.

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