Informed Consent and Patient Self-Determination
Case Study 1
Due to severe low back pain, the patient was admitted to the hospital and administered Dilaudid and Ativan to relieve the pain before an MRI. The MRI was delayed, but the patient verbally agreed to receive a second dosage of the medications. The patient later fell unconscious and experienced cardiopulmonary failure. The patient filed a lawsuit, alleging failure to obtain legally binding informed consent for the second dose of medication and persistent psychological symptoms (Horton & Lucassen, 2019).
Informed Consent for the Initial Medications
For a patient to make an educated choice regarding whether or not to endure a medical procedure, the patient must be fully informed about the procedure, including any potential benefits and risks. The informed consent process requires that the patient is competent to make their own decisions, is given enough information to make an informed decision, and gives voluntary consent (Horton & Lucassen, 2019).
In the case study provided, the physician explained the potential risks associated with Dilaudid and Ativan to the patient, including the risk of respiratory depression or arrest in patients on high doses of opiates. The patient agreed to be given the medications to numb his pain for the MRI. This indicates that the patient was competent to decide and voluntarily consented to the initial medications (Pietrzykowski & Smilowska, 2021).
It is worth noting that informed consent is an ongoing process, and any changes in the patient’s condition or the planned course of treatment may require obtaining additional consent. In this instance, the doctor received a new prescription and the patient’s vocal approval before administering the second dose of medications at 11:30 a.m. The patient subsequently filed a lawsuit, claiming that this second dosage was given without having received valid informed consent. The outcome of this claim is not provided in the case study (Shlobin et al., 2020).
Determination of Consent
Several elements must be taken into account to determine whether informed consent was provided for the MRI and the sedatives required for the test:
- Capacity to provide informed consent: It is important to determine whether the patient can provide informed consent. This includes assessing their cognitive abilities and ensuring that they are not under the influence of drugs or alcohol that could affect their decision-making ability (De Sutter et al., 2020).
- Disclosure of information: The physician should have provided the patient with information about the MRI procedure and the medications used for sedation. This includes explaining the purpose of the procedure, the risks and benefits, and any alternatives to the procedure (Jones, 2019).
- Understanding of information: The patient should have demonstrated an understanding of the information provided by the physician. This may involve asking questions to clarify uncertainties or seeking additional information (Utz et al., 2019).
- Voluntary decision-making: The patient should have voluntarily decided to undergo the procedure and receive the medications for sedation. This includes being free from coercion, pressure, or undue influence (Chen et al., 2020).
- Documentation: Informed consent should be documented in the patient’s medical record, including a description of the information provided, the patient’s understanding, and their voluntary decision to undergo the procedure (Jones, 2019).
By evaluating these elements, healthcare professionals can ascertain whether informed consent has been acquired for the MRI and the drugs required for the test’s sedation.
Lack of Informed Consent
It is unclear from the case study given whether the second dose of medication’s informed consent was inadequate. For the second dose of medications to be given at 11:30 A.M., it is claimed that the doctor received new orders and the patient’s verbal approval. The patient’s comprehension of the risks before giving consent will depend on whether the doctor provided the patient with extra information about any possible risks connected to the second dose of the medication (Pietrzykowski & Smilowska, 2021).
Later, the patient filed a lawsuit, alleging that the second medication dosage, which was given at 11:30 A.M., had not been given with legally binding informed permission. This implies that the patient might have thought the informed assent was not complete. In general, obtaining informed consent is an ongoing process, and any changes in the patient’s condition or the planned course of treatment may require obtaining additional consent. Healthcare providers must ensure that patients are fully informed about the potential risks and benefits of any medical procedures or treatments and that they understand and voluntarily consent to the procedures or treatments they receive (Shlobin et al., 2020).
Case Ruling
According to the case study given, it seems the patient had negative effects after getting the second dose of painkillers for the MRI, which caused him to become stuporous and eventually go into cardiopulmonary arrest. The patient later filed a lawsuit, alleging failure to acquire legitimate informed consent for the second medication dosage given at 11:30 A.M. and persistent psychological symptoms (De Sutter et al., 2020).
To decide the case, a court or jury would likely consider various factors, including whether the physician provided sufficient information about the risks and benefits of the medications, whether the patient understood the risks and voluntarily consented to the medications, and whether the administration of the second dose of medications was appropriate under the circumstances. It is also possible that the court or jury would consider whether the hospital staff responded appropriately to the patient’s adverse reaction to the medication, including whether they provided timely and appropriate care during a cardiopulmonary arrest (Utz et al., 2019).
Case Study 2
Due to severe side effects, Jimmy, a 15-year-old with two transplanted livers, ceased taking his immunosuppressive medications. Jimmy was readmitted to the hospital so that his medication could be restarted, and his physicians filed a lawsuit against his mother for endangering him. Jimmy, his mother, and the medical staff met with a juvenile court judge, but Jimmy said he wanted to cease taking the drugs because his life expectancy was short and he wanted to be pain-free. The medical staff was unable to ensure that the medications would significantly lengthen his life expectancy (Bhattacharya & Bhattacharya, 2020).
Understanding of Judge
Here are some inquiries the judge might pose to Jimmy to determine his level of maturity, his comprehension of the repercussions of his inaction, and any potential justifications for his request to make his own medical choices (Bhattacharya & Bhattacharya, 2020):
- Can you explain to me why you have chosen to stop taking the immunosuppressive medications?
- Do you understand the risks and consequences of not taking the medications?
- Can you explain what will happen if you continue not taking the medications?
- Are there any other medical treatments or alternatives that you have considered?
- How have you been managing your pain and discomfort caused by the medications?
- Can you tell me about your plans and goals?
- Do you have a support system to help you manage your medical condition?
- Have you discussed your decision with anyone else, such as a therapist or counselor?
- Do you have the necessary information and understanding to make this decision?
- Is there anything else you want to tell me about your situation or decision-making process?
Evaluation of Judge
The judge may assess the mother’s reaction to her son’s request in several ways based on the information given. The mother’s agony and worry for her son’s welfare may be taken into account by the judge as evidence of her deep love and desire for his best interests. However, the judge may also question whether the mother supports her son’s decision to stop taking immunosuppressive medications (Chen et al., 2020).
The mother’s claim that she believes her son would die sooner if he stopped taking the medications raises the possibility that she may not completely support his decision and may even be pressuring him to keep taking the drugs. However, her acknowledgment that her son is mature enough to make his own decisions indicates that she recognizes his autonomy and respects his right to decide about his healthcare. Overall, the judge would likely need to explore the mother’s views and attitudes toward her son’s decision to stop taking the medications to determine whether she truly supports his decision (Convie et al., 2020).
Impact of Residency Factor
As each state has laws and policies regarding medical decision-making for minors, the judge’s choice, in this case, may be influenced by the defendant’s residency state. For example, some states may have specific laws that allow minors to make their own medical decisions under certain circumstances, while others may require parental consent for all medical treatment. In this case, the judge would need to consider the relevant laws and policies in Florida, where Jimmy resides. However, the judge’s primary focus should be on determining what is in Jimmy’s best interest, considering his age, maturity, and ability to understand the consequences of his decisions. The judge’s decision should also be guided by the principle of informed consent, which requires individuals to be provided with all relevant information regarding their medical treatment to make an informed decision. Ultimately, the judge’s decision should prioritize the minor’s health and well-being while respecting their autonomy and ability to make decisions about their healthcare (Dankar et al., 2020).
Additional Issues
Yes, there might be other concerns that need to be resolved before this case’s result is decided. These might be a few of these problems:
- Jimmy’s current medical condition: It may be important to assess Jimmy’s current medical condition and prognosis to determine the potential risks and benefits of continuing or stopping the immunosuppressive medications (Convie et al., 2020).
- The impact of the medications on Jimmy’s quality of life: It may be important to understand their specific side effects and impact on Jimmy’s quality of life to determine the potential benefits and risks of continuing or stopping the medications (Ashley et al., 2021).
- The involvement of a healthcare team: It may be important to understand the role and expertise of the healthcare team in Jimmy’s care and to assess whether they have provided Jimmy and his mother with all relevant information regarding his medical treatment (Hariri et al., 2022).
- The availability of other treatment options: It may be important to explore options that may be less burdensome for Jimmy and assess whether these options have been adequately considered and discussed (Slim & Bazin, 2019).
- Jimmy’s emotional and psychological well-being: It may be important to assess Jimmy’s emotional and psychological well-being and to determine whether his decision to stop taking the medications is influenced by factors such as depression or anxiety (Slim & Bazin, 2019).
Overall, before deciding in this case, the judge should carefully consider all relevant factors and seek input from relevant healthcare professionals to ensure that the decision is in Jimmy’s best interest and respects his autonomy and right to make decisions about his healthcare (Nembaware et al., 2019).
Case Ruling
Based on the information provided, there are several factors that the judge should consider when making a decision:
- Jimmy’s age and maturity level: Jimmy, who is 15 years old, is getting near the point at which he can become an adult and possibly make his own healthcare choices. The judge should consider whether Jimmy can understand the consequences of his decision to stop taking immunosuppressive medications (Varkey, 2021).
- Jimmy’s current medical condition and prognosis: The judge should assess Jimmy’s current medical condition and prognosis and determine the potential risks and benefits of continuing or stopping the medications (Hariri et al., 2022).
- The impact of the medications on Jimmy’s quality of life: The judge should understand the specific side effects and impact on Jimmy’s quality of life to determine the potential benefits and risks of continuing or stopping the medications (Nembaware et al., 2019).
- The involvement of a healthcare team: The judge should assess the role and expertise of the healthcare team in Jimmy’s care and determine whether they have provided Jimmy and his mother with all relevant information regarding his medical treatment (Froomkin, 2019).
- Jimmy’s emotional and psychological well-being: The judge should assess Jimmy’s emotional and psychological well-being and determine whether his decision to stop taking the medications is influenced by factors such as depression or anxiety (Ashley et al., 2021).
Based on these factors, the judge should decide that it is in Jimmy’s best interest and respect his autonomy and right to decide about his healthcare. The judge may also consider alternatives to the current treatment plan, such as exploring other treatment options that may be less burdensome for Jimmy. Ultimately, the decision should prioritize Jimmy’s health and well-being while respecting his autonomy and ability to make decisions about his healthcare (Slim & Bazin, 2019).
Conclusion
Informed consent is a legal and ethical requirement that must be obtained before a patient undergoes any medical treatment or procedure. It entails giving the patient all pertinent information about the procedure or treatment, including the advantages and disadvantages, different treatment choices, and potential outcomes. The patient must then be able to understand the information provided and voluntarily consent to the treatment or procedure based on that understanding. The conclusion emphasizes the importance of considering ethical and legal perspectives in making decisions about a patient’s healthcare, respecting their autonomy, and prioritizing their health and well-being.
References
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