Consent is a tricky issue in healthcare. Every procedure performed by a healthcare
professional requires consent. It can be
obtained in three ways:
Informed Consent
– the procedure is explained to the patient (in language they can comprehend),
including any options and possible outcomes.
The patient agrees or refuses. A
signed form is sometimes obtained.
Implied Consent –
the procedure is explained to the patient and they indicate with their body
language that they consent (e.g., rolling up a sleeve for a blood draw or
sticking out a tongue for a strep culture).
Assumed/Presumed
Consent – the patient is unconscious, but it is assumed that they would
want life-saving measures taken as needed.
Once the patient becomes conscience, informed consent is obtained.
The distinction between these consent lines is sometimes
blurred, but for liability purposes, healthcare professionals should obtain
informed consent on any invasive procedure.
Using language the patient understand is crucial – we don’t want
patient’s agreeing to something simply because we suggest it – that is
considered paternalism and prevents the ability of a patient to make an
informed choice. A culture of patient
autonomy depends on providing as much information to the patient as possible and
allowing them to make an educated choice.
Enter the situation in Salt Lake City. A nurse was recently arrested for refusing to
draw blood from an unconscious patient. The patient could not give informed consent,
was not under arrest (which causes an individual to lose certain rights), and
the blood draw was not for medical purposes.
The police officer forcibly removed the nurse from the hospital in
handcuffs. She was later released and
not charged. The police officer was put
on administrative leave and the incident gained national attention. As a result, the hospital created a new policy
– all police officers must stay out of clinical areas and must go through a
liaison versed in health law and ethics.
There is also an ongoing federal investigation.
What can we learn from this incident?
1.
Healthcare administrators need to make sure that healthcare
professionals understand patient rights, including consent.
2.
Hospitals and HCO’s need to have clear policy for outside authority –
including police, firefighters, federal agents, etc.
3.
A clear chain of command needs to be in place to avoid situations from
escalating to violence in a healthcare setting.
Obviously, it is easy to look at this
situation and list all the problems. It
would be better to use this issue as a teachable moment. Here we have a healthcare professional ready
to defend patient rights to the end.
That is an amazing culture for a HCO to have developed. Follow up is needed to ensure the support for
that healthcare professional exists beyond just her own integrity.
Valerie Connor, MA CCC-SLP; MS CHES
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