Informed consent of the critically ill patient and drug therapy: legal aspects

2013 ◽  
Vol 4 (2S) ◽  
pp. 21-30
Author(s):  
Riccardo Fresa
Keyword(s):  
Informed Consent ◽  
Legal Aspects ◽  
Third Parties ◽  
Legal Issues ◽  
Self Determination ◽  
Critically Ill Patient ◽  
Patient Relationship ◽  
Life Meaning ◽  
Consent To Treatment ◽  
To Receive

Legal issues concerning the doctor-patient relationship are numerous, and belong to the wider field of professional liability in health care. This article will be dealt with the issues related to informed consent in patients temporarily unable to express consent, or patients who are in a state of temporary incapacity. If the patients are temporarily incapable, and therefore are not able to receive the information nor to express consent to treatment, the physicians’ duty to provide medical treatment and the patients’ self-determination should be considered: the patients can consent or refuse treatment only if able to understand the significance of their decision. If a patient is temporarily unable to give consent and the practitioner doesn’t have at his/her disposal a valid document reporting the patient’s wishes, it’s necessary to rely on the so called “amministratore di sostegno” (introduced in the Italian legal system by Law n. 6 of January 9th, 2004). But in the case of not deferrable treatment, as a lifesaving intervention, the rule is in dubio pro life meaning that a doctor is always legitimized by this situation of urgent need, regardless of the informed consent of the patient and/or third parties.

Overview of Legal Issues in Psychiatry

2017 ◽  
Author(s):  
Tracy D. Gunter
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Forensic Psychiatry ◽  
Medical Decision Making ◽  
Third Parties ◽  
Legal Issues ◽  
Medical Decision ◽  
Patient Relationship ◽  
Treatment Provider ◽  
Regulatory Issues

Psychiatrists routinely encounter legal and regulatory issues in the practice of psychiatry. This review provides an overview of the psychiatrist’s duties and responsibilities in the doctor-patient relationship and common legal issues arising in clinical practice, with reference to US statutory and regulatory practices. The field of forensic psychiatry is described, and the roles of the forensic evaluator and the treatment provider are compared. This review contains 2 figures, 5 tables, and 64 references. Key words: civil commitment, confidentiality, duty to third parties, forensic psychiatry, guardianship, gun ownership, medical decision making, medical marijuana, risk assessment 

On the Legal Aspects of Tardive Dyskinesia

1979 ◽  
Vol 7 (3) ◽  
pp. 295-331 ◽  
Author(s):  
Ralph Slovenko
Keyword(s):  
Informed Consent ◽  
Tardive Dyskinesia ◽  
Antipsychotic Medication ◽  
Standard Of Care ◽  
Legal Aspects ◽  
Legal Issues ◽  
Institutionalized Patients ◽  
The Right ◽  
Causal Nexus

Of the various drug therapies, the antipsychotic medication is presenting some novel twists to old issues in law and psychiatry. From what is known, its benefits are high but so are its risks. To wit, the risk of tardive dyskinesia. Presented here for consideration are legal issues of standard of care, informed consent, the right of institutionalized patients to refuse treatment, statute of limitations, and causal nexus.

Argumentation and informed consent in the doctor–patient relationship

2012 ◽  
Vol 1 (1) ◽  
pp. 5-18 ◽  
Author(s):  
Jerome Bickenbach
Keyword(s):  
Health Care ◽  
Informed Consent ◽  
Patient Autonomy ◽  
Argumentation Theory ◽  
Necessary Condition ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Consent To Treatment

Argumentation theory has much to offer our understanding of the doctor-patient relationship as it plays out in the context of seeking and obtaining consent to treatment. In order to harness the power of argumentation theory in this regard, I argue, it is necessary to take into account insights from the legal and bioethical dimensions of informed consent, and in particular to account for features of the interaction that make it psychologically complex: that there is a fundamental asymmetry of authority, power and expertise between doctor and patient; that, given the potential for coercion, it is a challenge to preserve the interactive balance presumed by the requirement of informed consent; and finally that the necessary condition that patients be ‘competent to consent’ may undermine the requirement of respecting patient autonomy. I argue argumentation theory has the resources to deal with these challenges and expand our knowledge, and appreciation, of the informed consent interaction in health care.

Overview of Legal Issues in Psychiatry

2017 ◽  
Author(s):  
Tracy D. Gunter
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Forensic Psychiatry ◽  
Medical Decision Making ◽  
Third Parties ◽  
Legal Issues ◽  
Medical Decision ◽  
Patient Relationship ◽  
Treatment Provider ◽  
Regulatory Issues

Psychiatrists routinely encounter legal and regulatory issues in the practice of psychiatry. This review provides an overview of the psychiatrist’s duties and responsibilities in the doctor-patient relationship and common legal issues arising in clinical practice, with reference to US statutory and regulatory practices. The field of forensic psychiatry is described, and the roles of the forensic evaluator and the treatment provider are compared. This review contains 2 figures, 5 tables, and 64 references. Key words: civil commitment, confidentiality, duty to third parties, forensic psychiatry, guardianship, gun ownership, medical decision making, medical marijuana, risk assessment 

scholarly journals Consent in psychiatry – an ethical review

2003 ◽  
Vol 27 (08) ◽  
pp. 285-289 ◽  
Author(s):  
Peter Lepping
Keyword(s):  
Clinical Work ◽  
Legal Aspects ◽  
Legal Issues ◽  
Ethical Review ◽  
Historical Overview ◽  
High Profile ◽  
Consent To Treatment ◽  
Ethical And Legal Issues

The aim of this article is to give a historical overview of the concept of consent to treatment and its development – one of the most important ethical and legal issues in recent years. Through the discussion of a number of high-profile examples, it deliberates the ethical and legal aspects of consent to treatment today and their implications for psychiatrists' clinical work.

Dealing with Third Parties

2017 ◽  
pp. 506-518
Author(s):  
Joe Scroppo
Keyword(s):  
Third Parties ◽  
Legal Issues ◽  
Third Party ◽  
Mandated Reporting ◽  
Patient Relationship ◽  
Court Order ◽  
Treatment Relationship ◽  
The Relationship

This chapter provides guidance on managing the ethical, regulatory, and legal issues that arise when a third party seeks to intervene in the psychotherapist–patient relationship. The chapter reviews the concepts of confidentiality and privilege. The author identifies types of third parties that may try to impinge on the psychotherapist–patient relationship, discusses ways in which third parties can enter the relationship, and identifies reasons for such impingement. A set of guidelines that psychotherapists can apply when confronted with an attempted or actual third-party penetration of the treatment relationship is offered. The following situations are covered: when a psychotherapist is mandated to involve a third party in the relationship (mandated reporting); when a patient authorizes a psychotherapist to involve a third party; when there is a legal demand for involvement in the relationship (subpoena or court order); and when the psychotherapist or client invite a third party into the relationship.

Giving and taking: ethical treatment assignment in controlled trials

2021 ◽  
Vol 114 (11) ◽  
pp. 525-530
Author(s):  
Stephen Senn ◽  
Iain Chalmers
Keyword(s):  
Informed Consent ◽  
Clinical Care ◽  
Controlled Trials ◽  
Current Version ◽  
Treatment Assignment ◽  
Declaration Of Helsinki ◽  
Effective Care ◽  
Consent To Treatment ◽  
To Receive ◽  
Trial Participants

The current version of the Declaration of Helsinki states that ‘the benefits, risks, burdens and effectiveness of a new intervention must be tested against those of the best current proven intervention(s) … ’. This wording implies that it is acceptable for patients to be assigned to receive an unproven new intervention and to be denied a best current proven intervention. We assert that patients being invited to participate in controlled trials cannot, ethically, be expected to forego proven beneficial forms of care. Patients being treated in controlled trials should not knowingly be disadvantaged compared with similar patients being treated in usual clinical care, where they have access to beneficial care. In this article, we have tried to separate for discussion ‘the withholding of effective care from trial participants’, ‘informed consent to treatment’, ‘blinding’ and ‘use of placebos’.

scholarly journals Consent in psychiatry – an ethical review

2003 ◽  
Vol 27 (8) ◽  
pp. 285-289 ◽  
Author(s):  
Peter Lepping
Keyword(s):  
Clinical Work ◽  
Legal Aspects ◽  
Legal Issues ◽  
Ethical Review ◽  
Historical Overview ◽  
High Profile ◽  
Consent To Treatment ◽  
Ethical And Legal Issues

The aim of this article is to give a historical overview of the concept of consent to treatment and its development – one of the most important ethical and legal issues in recent years. Through the discussion of a number of high-profile examples, it deliberates the ethical and legal aspects of consent to treatment today and their implications for psychiatrists' clinical work.

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