Informed Consent

Describe the ethical and legal aspects of patient autonomy and self-determination.

 * Four principles:
 * autonomy --> patient self-determinism
 * non-malfeasance: do no harm
 * integrity: be truthful, create trust
 * justice: fair allocation of resources
 * Though roots are in ancient Greece, ethics of patient autonomy were codified at Nuremberg:
 * able to consent
 * free from coercion
 * understand risks and benefits

Describe the specific elements of decision-making capacity.
Different from the legal definition of "competence"
 * Understands basic information
 * Appreciates consequences
 * Evaluates information rationally
 * Communicates decision
 * Age:
 * 18 or over for all procedures,
 * 16 for blood donation
 * 15 for some surgeries, elective care in Oregon
 * 14 for mental health, substance treatment
 * any for birth control/STDs, etc

Define the ethical and legal requirements of disclosure (PARQ): nature of the procedure, alternatives, risks and questions.

 * P: Procedures
 * A: Alternatives
 * R: Risks
 * Q: Questions

Identify issues complicating informed consent in special circumstances

 * Medical emergency
 * Incapable adult
 * Minor when consent by parent was refused (e.g faith healing)
 * Telephone informed consent
 * Research informed consent