The goal of the decision-making process is to make decisions that the patient would make and, when it is not possible to determine what the patient would want, to make decisions that are in the best interests of the patient.Guardians and Healthcare AgentsGuardian of person◦Courts may limit powers◦Guardian of estate (property) are not necessarily also the guardian of personHealthcare agent◦Designated in AD or Medical Power of AttorneyIn most states, the power to act as healthcare agent begins when the AD is activated. Activations occur when healthcare providers document their determination that the patient lacks decision making capacity.Others Making Decisions for Adults without Decision making CapacityPhysicians Orders for Life-Sustaining Treatment (POLST) also referred to as Medical Order for Scope of Treatment (MOST)◦Covers several common decisions for chronically ill patients (e.g., CPR)Family/friends assuming supervision of patient◦Most states have priority list◦Usually spouse, domestic partner, adult children, parents
Tuesday, February 28, 20174When Can Minors Make Their Own Decisions?As permitted by statute◦Generally: reproductive health, STDs, mental health, drug abuse and their own childrenEmancipated minorsMature minors◦Rule of sevens◦More legal risk with elective or high risk care The “mature minor” doctrine has been recognized by the U. S. Supreme Court in cases involving decisions to have an abortion.Who Makes Decisions for Minors Who Cannot Decide for Themselves?Guardian◦Frequently limited authorityParent◦Either when married◦Usually either parent when divorced (must see the court order!)Agents for the parentOther relativesPersons with custodyConsent of the parent or guardian should be obtained before treatment is given to a minor unless it is (1) an emergency (2) one of the situations in which the consent of the minor is sufficient, or (3) a situation in which a court order or other legal authorization is obtained.What information Needs to be Given to the Decision Maker?Patient engagement and communication through informed consent may also improve patient compliance, outcomes, and satisfactionThe general rule is that consent for most treatments must be an informed consent. This means that the treating provider is required to give the decision maker several elements of information before the consent decision.
Tuesday, February 28, 20175When Is Informed Consent Required?Only for services that are providedInformed refusalA physician did not inform a patient of the risks of not consenting to a pap smear, and the patient dies of cervical cancer. Could the physician be liable?What Elements of Information Concerning the Treatment Should be Given?Physician standard – accepted medical practicePatient standard – patient’s needs, issues material to the decisionElements- diagnosis; procedure nature & purpose, risks/benefits; and risks/benefits of doing nothing.Regulatory statusResearch
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- Spring '08