Informed Consent And Counselling PDF

INFORMED CONSENT AND COUNSELLING Natasha Namuziya INFORMED CONSENT Introduction- standard care Practice of medicine is governed by a system of beliefs that guide the health care professionals to act and make decisions that are regarded as ethically acceptable Different sets of standard co...

INFORMED CONSENT AND COUNSELLING Natasha Namuziya INFORMED CONSENT Introduction- standard care Practice of medicine is governed by a system of beliefs that guide the health care professionals to act and make decisions that are regarded as ethically acceptable Different sets of standard concepts of ethically acceptable behaviour exist. Eg Hippocratic oath, nurses oath, doctors oath etc Duties of health care providers Make the care of your patient your first concern Treat every patient politely and considerately Respect patients’ dignity and privacy Listen to patients and respect their views Give patients information in a way they can understand Respect the rights of patients to be fully informed in decisions about heir care Keep your professional knowledge up to date Recognize the limits of your professional Duties of health care providers  Be honest and trustworthy Respect and protect confidential information Make sure that your personal beliefs do not prejudice your patients’ care Act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practise Avoid abusing your position Work with colleagues in the ways that best serve patients’interests Principles of Ethical Practice Autonomy: Nonmaleficence: Beneficence: Justice: Fidelity: Autonomy Individual’s self determination and right to direct ones own life through his/her own decisions, beliefs Patient is primary decision-maker with respect to his/her own health. Others (eg physicians) must respect a patient’s right of self-determination. Beneficence Duty to do good on behalf of others Active promotion of good of the patient and not just shelter him/her from harm. Requires the performance of positive acts to advance the well-being of others Nonmaleficence ‘Do no harm’ Describes the need to prevent harm and to refrain from harmful acts Justice Need to treat all persons fairly Fidelity make honest promises / don't deceive / exploit clients Obtaining informed consent is not an isolated event It involves a continuing dialogue between doctor and patient Types of consent Express consent - oral or written Needed for most investigations or treatments with risks attached e.g. consent for operation Implied consent Non-written consent when patient co-operates with a particular action e.g. physical examination Information required for valid consent Informed consent should include information about Diagnosis Nature and purpose of the procedure Risks of the procedure Likelihood of success Reasonable alternatives Prognosis if no treatment is refused Uncertainties about the diagnosis Options available for treatment The purpose of a proposed investigation or treatment The likely benefits and probability of success Any possible side effects A reminder that the patient can change his or her mind at any stage A reminder that the patient has the right to a second opinion All questions should be answered honestly Information should not be withheld that might influence the decision making process Patients should not be coerced The person who obtains consent must be: Suitably trained and qualified Have sufficient knowledge of the proposed treatment and its risks Informed consent Legal doctrine that requires health care professionals to obtain consent for diagnosis, treatment, therapeutic, medical or surgical, invasive or non invasive Failure to obtain consent can result in ‘battery’ under common law whether tx appropriate within the std law How much information Reasonable physician std Reasonable patient viewpoint std Specific problems No-one else can make a decision on behalf of a competent adult No-one can give or withhold consent on behalf of a mentally incapacitated patient Court approval should be obtained for controversial treatments not directed at a metal disorder In an emergency a life-saving procedure can be performed without consent All actions must, however, be justifiable to ones peers Consent in special cases Minors – juvenile act ?21yr /18 /16 Parents or legal guardian If no parents or guardian; court may commit them to ‘fit person’ who is defined as:-  The commissioner for juvenile welfare; or  An approved member of society; or  Any person willing to undertake the care of juvenile.  Superintendent of approved reformatory sch. if child is under such institution Spouse – has no right to compel partner to undergo an operation or examination  Consent in special cases Mentally disordered or defective person Magistrate makes a ‘control order’ specifying which person to take care or control over mentally ill person. Eg relative, friend, chief, headman etc Consent in special cases Tx without consent in emergency cases Emergency threatens death or serous bodily harm and no time to obtain consent. Consent is ‘implied’. Defence of necessity would prevail Tx should be in the best interest of the patient Where prior to his/her present state of inability a patient deliberately and in full control of his senses, forbade medical treatment of any kind, any treatment will be against his will. EXAMPLES The sister in-charge calls you at 02:00hrs to come review and counsel a 18yr old girl with a suspected ruptured ectopic pregnancy who is declining any sgy intervention. 16yr old comes in c/o PVB and declines a pelvic examination because she is a virgin. COUNSELLING 21yr PG came in for her ANC booking visit and was found to be HIV positive. She is worried her baby may acquire HIV. MS comes to your clinic, with a hx of not being able to have a baby. She stopped taking COCs 3 years ago and since then her periods have become very infrequent. In the past months, she has noticed a white discharge from her nipples? Please counsel her What is Counselling 1.“A conversation with a therapeutic purpose” (Korchin, 1976) 2.“The purchase of friendship” (Schofield, 1964) 3.“[A] situation in which two people interact and try to come to an understanding of one another, with the specific goal of accomplishing something beneficial for the complaining person” (Bruch, 1981) the 6 principles 1.Treat each client well ---be polite, respect every client, create feeling of trust, assure confidentiality 2.Interact Listen Learn Respond Be understanding to clients needs, concerns, and situation 3.Tailor information to the client By listening Consider client situation Personalizing of information Bridges the gap between providers knowledge and the clients understanding 4.Avoid too much information Too much information makes it hard to remember really important information. This has been called information overload. Also little time for discussion 5 Provide the method that the client wants Help clients make choices and respect them Consider appropriateness of the method, benefits, advantages, disadvantages, side effects----informed choice Help the the client understand and remember Show flip charts, posters, pamphlets, pictures Show how they are used Let client handle them Or give a website The 6 steps The GATHER steps G---Greet clients In an open respective manner Observe privacy, confidentiality Be ready to help and explain what the clinic can offer A---Ask clients about themselves Intentions, concerns, wishes, Current health and family life If client has a particular FP method in mind T—Tell clients about choices H---Help clients make an informed choice E----Explain fully how to use the chosen method. R---Return visits should be welcomed Discuss and agree when the client will return for follow up or for more supplies, if needed. Also invite the client to comeback anytime for any reason Remember to Be humble, empathetic, helpful scenarios 39yr old G4 P3, at 36weeks GA presents to you in clinic asymptomatic but with proteinuria 3+ and BP 180/120 with a breech presentation. Explain your plan management VJ 26yr old and 12wks pregnant.She has a nephew with down syndrome and she is worried that her child may have Down Syndrome EW 19yr UNZA student, she has come to get her STD results. She is very anxious and has so many questions Hysterectomy BTL Jehovah’s witness Contraception Abortions