Autonomy of Individuals with Alcohol-Related Disorders: Informed Consent and Empowerment
João Paulo Barbosa Azevedo
Journal of Addiction & Addictive Disorders, 12 April 2023
Informed consent is a central concern in the care practice of individuals with alcohol- related disorders, with research and clinical practice indicating that they often refuse or abandon treatment early. In the relational care encounter it is important not only to recognize the patient as the subject of will and decision-making power, but also to pay attention to the experiences of vulnerability and the importance of promoting autonomy. These issues are particularly relevant when individuals with alcohol-use disorders come to treatment suffering from coercion or disturbed by anxiety and/or depression. A study on informed consent ethical practice was conducted on a sample of 85 professionals from the Addictive Behaviours and Dependencies network of the Regional Health Administration of the North, Portugal. A questionnaire was used to survey ethical attitudes. The results suggest the importance of reinforcing the practice of informed consent of individuals with alcohol-related disorders suffering from coercion, anxiety or depression as a place of a psychological empowerment process.
Informed consent with people judged incapable of legally consenting
Amy Bittick, Ryan Holliman
Advances in Mental Health and Intellectual Disabilities, 6 April 2023
The purpose of this study is to consider informed consent with those who may be legally judged incapable of consent. Frequently individuals with traumatic brain injuries and intellectual disabilities may fall into this category. This paper seeks to consider aspects of guardianship, moral and legal implications and best practices for mental health professionals.
This practice piece reviews literature regarding informed consent, as well as pertinent issues in the professional literature regarding types of guardianship as well as the occurrence of “Lucid intervals.” Furthermore, literature from moral philosophy and current legal research was examined to fully provide readers with a grasp of the legal and ethical landscape of this issue.
The paper finds that treating consent as a one-time binary event is lacking in both practicality and nuance. Moral philosophy and issues regarding paternalism are raised, as well as practice approaches to assessment of capability and how to engage in therapy in meaningful ways.
This paper provides insight into providing dignity-affirming therapy with a population that is often not considered in the literature of mental health ethics. When it is considered, the suggestions are so vague as to be of limited use. This manuscript provides nuance and practical applications to be a therapist that promotes dignity in those who might have varying levels of capacity to consent.
The Role of Different Aspects of Communication Behavior in the Assessment of Capacity to Consent
Luise Badenhoop, Stefanie Baisch, Susanne Penger, Julia Haberstroh
Journal of Gerontopsychology and Geriatric Psychiatry, 5 April 2023
Any medical treatment that interferes with physical integrity requires the informed consent of a patient capable of such consent. For people with dementia, the capacity to consent is questioned even in the early course of the disease. Particularly diagnostic instruments like the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) often deny people with dementia the capacity to consent because of high confounding of the results with patients’ verbal abilities. To date, it remains unclear whether not only verbal but also nonverbal communication is associated with assessments of capacity to consent. The current study investigates associations between patients’ verbal and nonverbal communication behaviors as assessed by the measure for Communication Behavior in People with Dementia in Ambulant Settings (CODEMamb) and capacity to consent as assessed by the MacCAT-T. We expected the strongest positive associations for verbal communication behaviors compared to nonverbal communication behaviors. Data of N = 43 patients with dementia (n = 8 capable of consent) were collected at two different German psychiatric clinics. The results show small to moderate correlations between the overall scores of CODEMamb and MacCAT-T. As expected, correlations were strongest for the verbal CODEMamb subscale. The results support current findings on the dependency of the MacCAT-T on verbal communication. Based on the findings, the discussion addresses how people with dementia can be enabled to make self-determined medical treatment decisions.
Informed Consent, Assent, and Confidentiality
Caring for the Hospitalized Child, May 2023 [American Academy of Pediatrics]
Informed consent is defined as the voluntary agreement of an individual or their authorized representative who has the legal authority to give such agreement. This consent must be exercised within the context of free choice, without any application of inducement or coercion. To give informed consent, an individual must have sufficient knowledge and understanding to be able to make a knowledgeable decision. Health care providers may have a different level of education and understanding than patients and their guardians. This knowledge gap can add complexity and potential misunderstandings to conversations surrounding informed consent…
Consent for the paediatric patient
Andrew Jones, James Hyde, Sharon Lee, Sondos Albadri, Laura Gartshore
Faculty Dental Journal, 1 April 2023; 14(2)
Obtaining valid consent is a fundamental process in dentistry. Written consent must be obtained where treatment involves conscious sedation or general anaesthesia. For children, consent may be provided by a person with parental responsibility (PR).
A retrospective evaluation was completed of 160 children over 2 UK hospital sites with paediatric services. Cases involving conscious sedation or general anaesthesia for dental treatment were selected. Data were obtained to establish whether it was documented that the correct person had provided consent for a child and whether all possible individuals with PR for the child were identified at the initial visit. UK national legislation and guidance was reviewed, from which a PR form (to determine PR status for a child) was created and implemented. A second evaluation was subsequently completed, again with 160 children.
Combined data from both sites confirmed documentation of an appropriate person providing consent in 127 cases (79%) in the first evaluation. This improved to 155 cases (97%) following implementation of the PR form. All possible individuals who had PR for the child were identified at the initial visit in 35 cases (22%). This improved to 139 cases (87%) following the introduction of the PR form.
Use of a PR form improved documentation regarding valid consent for children.
Editor’s note: This is a publication from the Royals College of Surgeons England.
Informed Consent: How much information is enough? In a Obstetrics and Gynaecology Department in Tertiary Care Hospital – An Interventional Study
Indian Journal of Forensic Medicine & Toxicology, 17(2), April-June 2023
Permission granted in full knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with knowledge of the possible risks and benefits. A process in which patients are given important information, including possible risks and benefits, about a medical procedure or treatment, genetic testing, or a clinical trial. This paper was an interventional study it was conducted in the Department of Forensic Medicine and Toxicology, Sri Manakula Vinayaga Medical College and Hospital, Madagadipet, Puducherry to audit and to improve it was conducted in the Department of Obstetrics and Gynaecology. The deficiencies were identified and it was analysed. The results of both pre-interventional and post-interventional were recorded, which showed the significant improvement in the consent form of the major and minor procedures. It is essential that this information be discussed in simple terminology that can be easily readily understood and help the patient to give proper consent for the procedures.
Traditional Health Care Practitioners’ Perspectives on Applying Informed Consent During African Traditional Medical Practice in Akwa Ibom State, Nigeria: A Cross-Sectional Qualitative Study
Francis Akpa-Inyang, Sylvester C. Chima
Journal of Integrative and Complementary Medicine, 17 April 2023
This study explored the perspectives of traditional health care practitioners (THPs) practicing in the areas of herbalism, bone setting, and traditional birth attendance, from Akwa Ibom state, Nigeria, on the possibility and implications of applying informed consent (IC) during African traditional medicine (ATM) practice.
Semistructured interviews were conducted with 11 THPs, consisting of 5 herbalists, 3 traditional bone setters (TBS), and 3 traditional birth attendants (TBAs), who represented the diverse groups that the study intended to cover. In-depth interviews were conducted using a semistructured guide and were recorded, transcribed, and analyzed using thematic analysis with the assistance of NVivo® qualitative analysis software.
Participants were seven males (64%) and four females (36%), 35–67 years of age, with 5–25 years of experience as THPs. Forty-six percent of participants were herbalists (27%), TBS, and TBAs (27%). Most participants (82%) were Annang, and (18%) were Ibibio first-language speakers. Three major themes emerged from the data analysis: (i) Existing ethical framework related to IC, (ii) knowledge of consent, and (iii) application of IC during traditional medical practice. These themes and relevant subthemes were explored. All (100%) THPs agreed that it was essential to communicate risks and benefits while allowing patients to ask questions before treatment. All participants (100%) stated that risk communication is essential in ATM, whereas 36% said they communicated all therapy benefits to their patients. Respondents believed patients could make an informed choice if they had complete information disclosure. However, THPs in this study had limited knowledge of formal IC rules and regulations.
This study revealed that THPs in this setting disclose a diagnosis, risks, some benefits, and treatment options to patients. Consent/agreement was obtained verbally and voluntarily during ATM practice, consistent with IC doctrine. THPs had limited knowledge of the critical elements of IC. However, they suggested that a form of IC that does not conflict with traditional African norms could be applicable in ATM. IC could facilitate documentation and help reduce risks in ATM practice.
Determination of the Readability Level of Consent Forms Used in the Gynecology and Obstetrics Clinic at Suleyman Demirel University
Cem Dağdelen, Evrim Erdemoğlu
Cureus, 5 April 2023; 15(4)
This study aimed to evaluate the readability level of consent forms used for interventional procedures in the obstetrics and gynecology clinic and to determine the readability of the texts according to the education level of the patient.
This study determined the readability of patient consent forms used before interventional procedures in the gynecology and obstetrics clinic at the Suleyman Demirel University Hospital, Isparta. The consent forms were divided into two main groups according to their use in obstetrics and gynecology procedures. The readability level of consent forms was assessed using two readability formulas developed by Ateşman and Bezirci-Yılmaz, which determine the readability level of Turkish texts in the literature.
When the consent forms were analyzed according to Atesman’s readability formula, they were found to be readable with more than 15 years of education at the undergraduate level, while according to Bezirci-Yılmaz’s readability formula, they were found to be readable with 17 years of education at the postgraduate level.
Easy-to-read consent forms will ensure that patients are more informed about interventional procedures and participate more effectively in the treatment process. There is a need to develop readable consent forms suitable for the general education level.
Editor’s note: Suleyman Demirel University is located in the Karasay region of Kazakhstan.
Cardiac Transplant in Southeast Asia: Challenges and Opportunities
Sulague, N. Cruz, R. Ricardo, P. Alfonso, D. Vervoort
The Journal of Heart and Lung Transplantation, April 2023; 42(4)
Among the 18.6 million cardiovascular deaths worldwide, 33.5% occurred in Southeast Asia, where cardiovascular diseases constitute 40.2% of all causes of mortality and injury. There is higher prevalence of symptomatic heart failure in Southeast Asian countries compared with the rest of the world. While advances improved cardiac transplantation, challenges remain to make it widely available. The study aims to discuss its challenges and opportunities in Southeast Asia.
A review of related literature was conducted on PubMed using combinations of variations of key terms such as cardiac transplant, heart transplant, Southeast Asia, and countries within the region. Ministries of health websites in the region were reviewed for cardiac transplant-related policies. The global burden of disease of heart failure-associated conditions from 2000 to 2019 in disability-adjusted life-years were assessed in the Southeast Asian region and other select geographical region using the Institute for Health Metrics and Evaluation Global Burden of Disease Results Tool.
Southeast Asia’s burden of disease is comparable to Western Europe but does not have the same high volume of cardiac centers, health workforce, and robust network of organ donors. Substantial financial risk protection remains limited for most of the countries. Main barriers to organ donation include knowledge gaps, sociocultural and religious restrictions, and lack of infrastructure. At present, all countries follow an opting-in system based on informed consent, except Singapore which follows an opting-out system based on presumed consent. Association of Southeast Asian Nations may be optimized to promote cooperation, physician mobility, improved training, and policymaking.
Southeast Asian countries may benefit from considering opting-out scheme for donation, implementing a national system for organ donation, forming a centralized body directing all transplant activities, and improving public health education on transplantation.
Understanding of informed consent by patients at the Faculty of Dentistry of the University of Costa Rica
José Manuel Fernández Chaves
Medicina Legal de Costa Rica, March 2023
Informed consent is the result of the evolution of the relationship between health professionals and their patients or users where the principle of autonomy is above anything else. There are many articles on informed consent but none of the studies found assessed whether patients really understand it. The objective of this research was to determine the level of understanding of informed consent by the patients of the Clinic of Oral Surgery of the Faculty of Dentistry of the University of Costa Rica, in the period August to September 2022, by means of a questionnaire that would allow correlating the understanding with the level of schooling.
Materials and methods
A questionnaire was administered to 100 people divided into two parts, one on sociodemographic data and the other to establish the understanding of informed consent and to determine whether the level of schooling was related to the understanding of the same.
The group between 20 and 30 years of age was the largest, of these 51% had university studies, and although the majority (98%) referred to knowing the concept of informed consent, only 33% obtained the correct answers to the clinical questions asked.
Even though patients refer to knowing what informed consent is the results suggest an unclear understanding of important concepts such as complications or immediate or late adverse reactions produced by the effect of dental treatments or surgical procedures.