Informed consent/refusal to medical treatment
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Informed Consent, Refusal, and Competence
i) You are a physician in a private medical practice. An 80-year-old male patient is seen in your office complaining of chest pain. He has been suffering from congestive heart failure for the past 5 years and has been under your care during this time. The patient's wife and daughter are present in the examination room with you. You conclude that tests and a possible surgical procedure are necessary, possibly to save the patient's life. During the examination, the patient states that he just wants to die, but there is no DNR or living will document in his chart. The spouse states that she wants to save her husband's life, but is extremely afraid of surgery. The daughter states that she wants to save her father's life under any circumstances.
(1) What would you do to determine the competence of this patient?
(2) Would you base your decision about competence, in part, on the patient's wish to die?
(3) How much would you base your actions on the wife's possibly irrational fear of surgery?
(4) How deeply should the daughter's opinions be considered?
(5) How would you persuade the patient to proceed with testing and treatment without coercion (paternalism)?
(6) If this was your patient, what would you do?
(7) What elements are needed for informed consent? From which special population do you think there would be the most difficulty in gaining informed consent and why?
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Solution Summary
Questions on informed consent/refusal for treatment are discusssed regarding an 80 year old male with history of congestive heart failure (CHF) who refuses a surgery that could possible safe his life, a wife who wants to save her husband but is afraid of surgery, and a daughter who wants to save her dad at all cost.
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Informed consent to medical treatment maybe one of the most controversial topic on health care because it raises difficult ethical and legal issues.
In this case you have an 80 year old male with history of congestive heart failure (CHF) who refuses a surgery that could possible safe his life, a wife (no age stated) who wants to save her husband but is afraid of surgery, and a daughter (no age stated) who wants to save her dad at all cost.
When a patient refuses treatment, it is important that the health care professional (HCP) makes sure the patient understand his condition and the treatment alternatives. There are certain situations like language barriers or family's presence in the room that can influence the patient's decision. In this case the family is present in the room. Once the family is asked to leave the room for a couple of minutes (maybe with the excuse to give privacy to continue the physical examination), the HCP (making sure a nurse or another HCP is present) should inquiry the reason for the patients refusal while explaining him one more time the procedure that could possible safe his life.
In life threatening situations where there is no DNR or living will paperwork done, if the patient continues to refuse, it is the duty of the HCP to make sure the patient understand the ...
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