Question

From The Law of Healthcare Administration 8th Edition (2012) by Showalter - Chapter 10.

1.What are the two types of consent for medical treatment? When does each apply?

2. What is the standard for consent in an emergency?

3. What is the hospital’s role in obtaining informed consent?

4. What is required for informed consent to be valid?

5. What is the parallel between Helling v. Carey in Chapter 4 and the cases in this chapter that disapprove of the “reasonable-doctor rule” for informed consent?

6. How does the principle of informed consent apply to competent patients who refuse lifesaving treatment? How does it apply to incompetent patients who have signed an advance directive?

7. How does informed consent apply to someone who had not signed an advance directive? To a newborn? To a mature minor?

8. Under what circumstances may consent be refused for the artificial administration of nutrition and hydration?

9. What are the advantages and disadvantages of living wills, DPOA for healthcare, statutory advance directives, and POLST/MOST forms?

10. What are the requirements of the PSDA?

Answer 1

1. What are the two types of consent for medical treatment? When does each apply?

The two types of consent for medical treatment can be express or implied. Express consent is when words are being exchanged, whether it is written or spoken, while implied consent is given with a patient’s action that shows agreement for treatment. Both consents require the patient to have legal competency with an adequate knowledge and understanding of the medical or surgical treatment. However, in emergencies, with implied consent, patient should be stabilized first before trying to obtain a consent. Today, there are two consent forms, general consent form and special consent form. A general consent form is for patients to grant the hospital permission to provide the basic care and nursing services during admission. This is typically signed during the registration process. The special consent form is designated for specific procedures and treatments. It should only be applicable after the surgeon or physician has conveyed all necessary information in layman’s terms and answered all patient questions. The special consent form should also provide documentation of possible unforeseen outcomes from the procedure and patient is aware and consenting to possible additional procedures at the physician’s discretion. The consent may only be signed if the patient has reasonable understanding of the consent and also may not be under the influence of any preoperative anesthetic medications.

2. What is the standard for consent in an emergency?

The standard for consent in an emergency in which the patient cannot be deemed competent, no consent is required. This is referred to as implied consent, in which the law assumes consent would be given had the patient been competent. An implied consent would be given in a true medical emergency that can be justified by the physician of the urgency in the situation that requires receiving consent in a timely manner. It also refers to a situation that may present an immediate danger of death or permanent damage.

3. What is the hospital's role in obtaining informed consent?

In obtaining an informed consent, a hospital’s duty is to determine whether the physician has fulfilled their responsibility to obtain the consent. The physician is responsible for discussing information related to the procedure and confirming an understanding. The physician is also responsible for answering any questions presented by the presented. The hospital is essentially responsible for implementing policy and procedures to ensure consent documentation before all procedures and treatments.

4. What is required for informed consent to be valid?

Informed consents must disclose the nature of the diagnosed condition, facts concerning the proposed surgery and an explanation of the probable risks involved. It must not be misrepresent the facts. Information on consequences must also be included in the informed consents, which also includes alternative course of treatments that may be available for patients. Risks associated to the patient should be disclosed according to the reasonable-doctor rule or the right-to-know rule, which are specific to the patient and the circumstances at hand. The informed consent must include diagnosis and prognosis, nature and purpose of proposed treatment, risks consequences, side effects, probability of success, reasonable alternatives, prognosis without treatment and type of recuperation likely.

1. What are the two types of consent for medical treatment? When does each apply?

The two types of consent for medical treatment can be express or implied. Express consent is when words are being exchanged, whether it is written or spoken, while implied consent is given with a patient’s action that shows agreement for treatment. Both consents require the patient to have legal competency with an adequate knowledge and understanding of the medical or surgical treatment. However, in emergencies, with implied consent, patient should be stabilized first before trying to obtain a consent. Today, there are two consent forms, general consent form and special consent form. A general consent form is for patients to grant the hospital permission to provide the basic care and nursing services during admission. This is typically signed during the registration process. The special consent form is designated for specific procedures and treatments. It should only be applicable after the surgeon or physician has conveyed all necessary information in layman’s terms and answered all patient questions. The special consent form should also provide documentation of possible unforeseen outcomes from the procedure and patient is aware and consenting to possible additional procedures at the physician’s discretion. The consent may only be signed if the patient has reasonable understanding of the consent and also may not be under the influence of any preoperative anesthetic medications.

2. What is the standard for consent in an emergency?

The standard for consent in an emergency in which the patient cannot be deemed competent, no consent is required. This is referred to as implied consent, in which the law assumes consent would be given had the patient been competent. An implied consent would be given in a true medical emergency that can be justified by the physician of the urgency in the situation that requires receiving consent in a timely manner. It also refers to a situation that may present an immediate danger of death or permanent damage.

3. What is the hospital's role in obtaining informed consent?

In obtaining an informed consent, a hospital’s duty is to determine whether the physician has fulfilled their responsibility to obtain the consent. The physician is responsible for discussing information related to the procedure and confirming an understanding. The physician is also responsible for answering any questions presented by the presented. The hospital is essentially responsible for implementing policy and procedures to ensure consent documentation before all procedures and treatments.

4. What is required for informed consent to be valid?

Informed consents must disclose the nature of the diagnosed condition, facts concerning the proposed surgery and an explanation of the probable risks involved. It must not be misrepresent the facts. Information on consequences must also be included in the informed consents, which also includes alternative course of treatments that may be available for patients. Risks associated to the patient should be disclosed according to the reasonable-doctor rule or the right-to-know rule, which are specific to the patient and the circumstances at hand. The informed consent must include diagnosis and prognosis, nature and purpose of proposed treatment, risks consequences, side effects, probability of success, reasonable alternatives, prognosis without treatment and type of recuperation likely.

5. What is the parallel between Helling v. Carey in Chapter 4 and the cases in this chapter that disapprove of the “reasonable-doctor rule” for informed consent?

once if we observed the given case, it is observed that Helling is the consulting doctor to Carey for long years, and the doctor suggest him some kind of glasses and lence to a better eye site. but in the process, Carey observes that he lost his eye power and not able wautch clearly and bring a suit against Helling. in the court Helling said that the result of any treatment is subjective to patient conditon, hence the utility of the patient is not upto the mark. and the result is this problem to the patient.

both parties raise their voices, but the court announced a statement to support of Carey, it is questionned by Helling in suprement court. they are waiting for announcement from the court.

6. How does the principle of informed consent apply to competent patients who refuse lifesaving treatment? How does it apply to incompetent patients who have signed an advance directive?

Informed consent is the process through which health care service providers give appropriate information to a competent patient so that the patient can make a voluntary decision whether he/she wants to accept the proposed treatment or refuse the treatment. In such cases i.e. cases involving competent patients the health care service provider has to provide the patient with reasonable alternatives to the proposed intervention. The health care service provider will also discuss the applicable risks and benefits of each alternative.

In case of patients who are incompetent and have signed an advance directive. The signing of the advance directive leads to the appointment of a substitute decision maker. In case of advance directive the patient (who is now incompetent) had already identified an individual who will respect that patient’s values and hence will be able to make substitute decisions on behalf of the now incompetent patient. In such a case the principle of informed consent will be implemented on the basis of a prior discussion that has been documented or on the basis of a living will or a durable power of attorney.

7. How does informed consent apply to someone who had not signed an advance directive? To a newborn? To a mature minor?

Informed consent basically is that the individual has been informed about his or her illness and the individual has given his or her consent for the proposed diagnosis treatment.

In cases where there is no advanced directive or informed consent, the default surrogate consent laws come into action. These laws have been proposed by the state government. These laws give the order of preference for the authority to the relatives of the individual, to sign the informed consent or advanced directive, on his or her behalf.

Please Other questions ask separately.Thanks