Dr KK Aggarwal
Consent taking is an integral
part of clinical practice. Doctors are required to obtain informed consent from
their patients before initiating treatment or carrying out any procedure,
therapeutic or diagnostic.
The concept of consent is
derived from the ethical principle of patient autonomy. Consent is
therefore an ethical obligation and legal requirement.
There are three components of
a valid consent:
·
The patient gives it
voluntarily without any coercion
·
The patient has the minimum of
adequate level of information about the nature of the procedure to which he is
consenting to.
·
The patient has the capacity
and competence to give consent
Criteria that have been deemed
to be necessary to reach to a decision by the patient regarding his/her
treatment have been defined: Understanding, expressing a choice, appreciation
and reasoning. Assessment of these criteria for decision making capacity is an
essential part of the process of informed consent.
Understanding: Is the patient able to grasp or comprehend the
meaning of the information provided to him/her by the doctor and retain that
knowledge? This includes information about the disease condition, the
proposed treatment or alternative treatments, the associated benefits and risk
of proposed treatments, alternative treatments as well as no treatment. The
ability to understand the relevant facts has a great role in the decision
making ability of the patient. Because if the patient does not understand the
information given, he/she cannot pick information that is relevant to their
situation. The information must be simple and clear and imparted in language,
which the patient can understand, avoiding too many medical terms. Memory
problems, intelligence can affect understanding of the information.
Expressing a choice: Is the patient able to clearly communicate to the
doctor his/her choice of preferred treatment option from the multiple proposed
treatment options and is the patient able to maintain a relatively stable
decision regarding treatment choice for it to be implemented? Patients may
often change their mind about their treatment choice and withdraw consent at
any time. This does not mean that the patient lacks the capacity to make a
decision if the patient is able to give a justifiable rationale for the change
in decision. However, frequent changes in decision making may put a question
mark on the capacity of the patient to come to a decision.
Appreciation: This component goes beyond the mere understanding
of the facts given to a patient. Is the patient able to relate the information
about the proposed diagnostic and treatment intervention and the likely
consequences to himself/herself directly? Whether the patient understands the
consequence of refusal of treatment?
Reasoning: Is the patient able to rationally use the relevant
information and give reasons for selecting a particular treatment option
keeping his best interests in mind? This component deals with the process by
which the patient arrives at a decision and not the final decision as chosen by
the patient. If a patient lacks reasoning, he/she will not be able to compare
the benefits and risk of various treatment options in a rational or logical
manner. Reasoning is affected in conditions like psychosis, depression, any
phobia, dementia.
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