Is Informed Consent Ever Truly Informed? [BOOK CHAPTER]
Johelen Carleton, Pringl Miller
Difficult Decisions in Surgical Ethics, 1 January 2022; pp 77-89 [Springer]
Abstract
The clinical ethical imperative to provide patients or their surrogate decision makers with relevant and tailored information is a serious endeavor that has challenged many generations of surgeons. The surgical informed consent process (SIC) is a critical aspect of surgical practice that is especially complex because patients are diverse individuals who do not automatically fit into algorithms. The sensitivity and specificity with which the SIC process must be embraced should be seen through the lens of each autonomous person. During SIC it is vital to understand what matters most to the patient. Only then can a surgeon facilitate a meaningful discussion that will honor a patient’s rights, dignity, preferences, goals and values. This chapter will address the evolution of the medicolegal and ethical aspects of the surgical informed consent process and how to optimally satisfy the communication needs. Additionally, this chapter will explore the adaptations to the surgical informed consent process during the COVID-19 pandemic.
Month: February 2022
Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent
Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent
Article
Hui-Mei Lin, Chih-Kuang Liu, Yen-Chun Huang, Chieh-Wen Ho, Mingchih Chen
International Journal of Environmental Research and Public Health, 31 December 2021; 19(428)
Open Access
Abstract
Background
The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation.
Objective
This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding.
Method
In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018.
Results
Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent.
Conclusions
This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.
Complex surgery and optimal consent: A variety of opinions exist among healthcare professionals
Complex surgery and optimal consent: A variety of opinions exist among healthcare professionals
Cillian Clancy, Niamh McCawley, John P. Burke, Deborah McNamara
The Surgeon, 29 December 2021
Abstract
Background
Establishing healthcare professional’s views on optimal consent in complex surgery could guide tailored consent policy, improving the process in challenging scenarios. To date, no studies have established if professionals of differing specialities agree on major aspects of consent in areas such as emergency surgery and cancer surgery.
Methods
An anonymous web based survey was distributed to a variety of disciplines in a tertiary referral centre. Questions regarding optimal methods and timing of consent in emergency and cancer surgery were posed. Comparative analyses of quantitative data were performed using chi-squared test.
Results
57 responses were received from doctors and nurses of varying disciplines. Differences were found between doctors of separate specialities and nurses in opinion of optimal timing of consent (p = 0.02), consent validity over time (p < 0.001) and the utility of introducing more specific consent policy (p = 0.01). Almost all respondents agreed that healthcare professionals have differing ideas of what consent is.
Conclusions
This study demonstrates differences in opinion regarding optimal consent for cancer and emergency surgery. Consideration should be given to developing consensus among healthcare professionals regarding what consent for complex surgery constitutes.
Automating Cookie Consent and GDPR Violation Detection [CONFERENCE PAPER]
Automating Cookie Consent and GDPR Violation Detection [CONFERENCE PAPER]
Dino Bollinger, Karelcc Kubicek, Carlos Cotrini, Davidcc Basin
USENIX Security Symposium 2022, Boston, MA, USA; 10–12 August 2022
Abstract
The European Union’s General Data Protection Regulation (GDPR) requires websites to inform users about personal data collection and request consent for cookies. Yet the majority of websites do not give users any choices, and others attempt to deceive them into accepting all cookies. We document the severity of this situation through an analysis of potential GDPR violations in cookie banners in almost 30k websites. We identify six novel violation types, such as incorrect category assignments and misleading expiration times, and we find at least one potential violation in a surprising 94.7% of the analyzed websites. We address this issue by giving users the power to protect their privacy. We develop a browser extension, called CookieBlock, that uses machine learning to enforce GDPR cookie consent at the client. It automatically categorizes cookies by usage purpose using only the information provided in the cookie itself. At a mean validation accuracy of 84.4%, our model attains a prediction quality competitive with expert knowledge in the field. Additionally, our approach differs from prior work by not relying on the cooperation of websites themselves. We empirically evaluate CookieBlock on a set of 100 randomly sampled websites, on which it filters roughly 90% of the privacy-invasive cookies without significantly impairing website functionality.
Privacy and Informational Self-determination through Informed Consent: the Way Forward [CONFERENCE PAPER]
Privacy and Informational Self-determination through Informed Consent: the Way Forward [CONFERENCE PAPER]
Mohamad Gharib
International Workshop on SECurity and Privacy Requirements Engineering (SECPRE), 4 January 2022
Open Access
Abstract
“I have read and agree to the Privacy Policy”. This can be described as one of the biggest lies in the current times, and that is all what a service provider needs to acquire what can be called “informed consent”, which allows it to do as it pleases with your Personal Information (PI). Although many developed countries have enacted privacy laws and regulations to govern the collection and use of PI as a response to the increased misuse of PI, these laws and regulations rely heavily on the concept of informational self-determination through the “notice” and “consent/choice” model, which as we will see is deeply flawed. Accordingly, the full potential of these privacy laws and regulations cannot be achieved without tackling these flaws and empowering individuals to take an active role in the protection of their PI. In this paper, we argue that to advance informational self-determination, a new direction should be considered. In particular, we propose a model for informed consent and we introduce a proposed architecture that aims at tackling existing limitations in current approaches.
Center for Informed Consent Integrity 