Informed decision-making

Informed decision-making and valid consent/refusal: principles

Students should be able to demonstrate in practice an understanding of legal and ethical aspects of:

  • informed consent, voluntariness and disclosure of diagnosis
  • patient refusal of treatment
  • the significance and limits of respect for patient autonomy
  • recognition of the legal and ethical boundaries of the clinical discretion to withhold information.


Informed decision-making and valid consent/refusal: teaching and learning resources

General

BioCentre Academic Paper search

 

Professional guidance

Consent: patients and doctors making decisions together, GMC (2008)

Consent tool kit, BMA (2009)

 

Medical Protection Society resources

Factsheet: Consent: children and young people

Factsheet: Consent: the basics

Medicolegal booklet: Guide to consent

Case reports illustrating medicolegal issues around consent

GP Registrar magazine: Consent (2009)

 

Department of Health publications

Reference guide to consent for examination or treatment (Second edition, 2009)

Better information, better choices, better health: Putting information at the centre of health, 2004

NHS Patient information toolkit

 

Books

Shriver L. So Much for That, London and New York: Harper Collins, 2010.shriver

Cover image Reprinted by Permission of HarperCollins Publishers Ltd.  © 2010 Shriver, L.

Role of internet and healthcare information, disclosure of diagnosis. Husband searches for information regarding his wife’s prognosis on the internet. Her prognosis is hidden from her at the oncologist’s recommendation until her husband tells her the truth when she has 3 weeks to live, improving the quality of the end of her life.

 

Films and documentaries

The Death of Mr Lazarescu (Romania, 2005). Mr. Lazarescu, a 63 year old lonely man feels sick and calls the ambulance. When it arrives, the paramedic decides he should take him to the hospital but once there they decide to send him to another hospital and then yet another... As the night unfolds and they can't find a hospital for Mr. Lazarescu, his health starts to deteriorate fast. (IMDB.com)

The Doctor (1991?). Jack McKee is a doctor with it all: he's successful, he's rich, and he has no problems.... until he is diagnosed with throat cancer. Now that he has seen medicine, hospitals, and doctors from a patient's perspective, he realises that there is more to being a doctor than surgery and prescriptions. (IMDB.com)

 

Informed consent, voluntariness and disclosure of diagnosis

Jones, M A, Informed Consent and Other Fairy Stories (1999) 7 Med L Rev p103-134

Gold, M, Is honesty always the best policy? Ethical aspects of truth telling, Intern Med J. 2004 Sep-Oct; 34(9-10):578-80

Chester v Afshar [2004] UKHL 41, [2004] 4 All ER 587 and case commentary (2005) 13 Med L Rev p102

Al Hamwi v Johnston [2005] EWHC 206

And commentary: Miola, J, Autonomy Rued Ok?, 2005 Med Law Rev 2007 14: 108-114

Fovargue, S, Miola, J, One step forward, two steps back? The GMC, the common law and ‘informed’ consent, J Med Ethics 2010; 36:494-497

 

Patient refusal of treatment

Re B (Adult: Refusal of Medical Treatment) [2002] EWHC 429

Interactive case studies

 

Recognition of the legal and ethical boundaries of the clinical discretion to withhold information

Johnston, C, and Holt, G, The legal and ethical implications of therapeutic privilege: is it ever justified to withhold treatment information from a competent patient? 2006 Clinical Ethics, 1(3) 46-151