Informed Consent: Ethical and Legal Implications

In this study, Laura a 16-years old girl has visited dentist’s office to be counseled about teeth removal. For the doctor to conduct this treatment painlessly there is a need for injecting her with anesthesia. Laura’s mother has, however, finished filling both intake and informed consent documents for her where she has indicated this patient is not pregnant. While Laura is in the chair and the physician is ready for administering anesthesia, the girl tells the doctor that she thinks she is pregnant. Since anesthesia is not suitable for pregnant individuals, this paper will denote the appropriate measures, which need to be taken. Indeed, the research question is as follows: what are the ethical and legal implications of this confusion?

The Information to be Answered in this Prompt

In the scenario where Laura’s mother has made a mistake of marking on the informed consent form that her daughter is not pregnant, I am going to denote legal implication of already occurred error. For instance, I will provide a comprehensive understanding of ethical and legal issues that will be implemented to ensure that Laura’s medication is done without the emergence of any conflict. Moreover, this essay provides the lawful problems that will be affected by the decisions, which will be taken by the health care officers (Bolt & Van Summeren, 2014).

Legal Sources Required for Tackling the Research Question

There are numerous legal sources, which facilitate the attainment of quality and detailed outcomes of this topic. For instance, there is need of considering various statutes since they provide directives of solving different issues that happen on a daily basis. At this point, the process of answering this question will be based on the rule of law hence ending up arguing about majority’s ethical views. On the other hand, while writing this paper, it is essential to concentrate on the administrative decisions. Indeed, the alternatives and ideas given by the governmental bodies will also help in solving the existing issues in an unbiased way. Moreover, the court decisions will pave a way of arriving at the proper conclusion since these stipulations indicate the principles and policies used while solving cases similar to that of Laura. Additionally, this assignment should be done in consideration of clinical guidelines and procedures as dictated by the medical officers guiding various medications happening within the health sectors.

The Databases to Be Used on Answering the Research Question

Numerous databases will be used as tools for searching scholarly materials necessary for aiding the completion of the research about Laura’s case. For instance, the EBSCO website will provide the essential information for compiling this task. This database contains school libraries, academic libraries, medical institutions, public libraries; military institutions and it also have information about corporations. The other databases will be Google Scholar, a search engine indexing the full knowledge or metadata concerning scholarly prose across various publishing disciplines and formats. Moreover, World Health Organization (WHO) database will offer multiple global views about clinicians who have applied different principles while handling informed consent based issues. Additionally, the database about the United States government laws will also provide legal and ethical procedures, which need to be followed in cases where someone breaches specific rulings or policies.

Annotated Bibliography

• Parsapoor, A., Parsapoor, M.B., Rezaei, N., & Asghari, F. (2014). Autonomy of children and adolescents in consent to treatment: Ethical, jurisprudential and legal considerations. Iranian Journal of Pediatrics, 24(3), 241.

This article is about the autonomy of the adolescents and children in the view of consent treatment. The authors have provided various legal, jurisprudential, and ethical factors to be considered in cases where there emerge errors while filling the intake or informed consent forms. The writers of this piece say that autonomy is the central principle to be considered while making choices regarding personal health. This article indicates that in some extents the adolescents have the capacity of making their decisions during medication. In most instances, the parent-doctor-adolescent/child relations need to be observed while getting into agreement hence avoiding messing up while handling professional duties. In this context, it is proposed that parents need to end the habits of making decisions of the children who have the capability of expressing themselves. However, if the child is unable to make choices by his or her own, then the parents can, therefore, be allowed to talk on behalf of the patient. Based on the above information, it is clear that even if the consent form is already filled, the physicians will have to consider the argument of Laura.

• Coleman, D.L., & Rosoff, P.M. (2013). The legal authority of mature minors to consent to general medical treatment. Pediatrics, 131(4), 786-793.

The authors of this article have explained the legal authority of mature minors in deciding on their conventional medical treatment. These writers have started by saying that the scope and nature of adolescents’ power on allowing the physicians to treat them without parental influence is vital since it depletes chances of misrepresentation. However, youths consenting is further complicated by the ruling due to the establishment of “mature minor exception” law. The above enactment indicates that the parents can also be involved in deciding serious cases, hence, the government has made a specific condition-based and status-based exemptions regarding complicated scenarios. The authors have concluded that it is not always easy for healthcare professionals to adhere to applicable laws hence indicating that the form filled by Laura’s mother maybe ignored since she did not consult her daughter while filling it (Coleman & Rosoff, 2013).

• Hein, I.M., Troost, P. W., Broersma, A., De Vries, M.C., Daams, J.G., & Lindauer, R.J. (2015). Why is it hard to make progress in assessing children’s decision-making competence?. BMC Medical Ethics, 16(1), 1.

This article shows the factors making it difficult to evaluate the competence of decision making among children. The authors have found that the power of making choices is a vital element as far as informed consent is concerned. The article provides an example of a pediatrics, where physicians are supposed to strike a suitable equilibrium to both protect the interests of kids as well as considering their autonomy. However, the children’s proficiency in authority is not scrutinized following the required standards. The authors have realized that the common law has failed to correlate age and informed consent, hence, there are no specific factors which determine the adolescent’s competence. As a result, there are chances that the physicians will not heed the opinion raised by Laura because of her age.

• Kinnersley, P., Phillips, K., Savage, K., Kelly, M.J., Farrell, E., Morgan, B. ... & Blazeby, J. (2013). Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. Cochrane Database Syst Rev., 7CD009445.

This article has provided interventions for promoting informed consent to adults undergoing invasive healthcare procedures. The authors consider that the acceptable ethical and legal principle denote that before instigation of any healthcare procedure, the clinician should obtain the informed permission from the patient. The consenting should be done by clinicians discussing the current issues with the patient, hence, determining the suitable intervention to be used. Moreover, the conversation will make the client understand procedures to be involved, familiarize with the benefits and risks of the medication as well as offering them with alternative treatments. About this article, it is clear, that the physicians can only act ethically by embracing Laura’s demand and ignoring information forwarded by her mother.

• Wilhelms, E. A., & Reyna, V. F. (2013). Fuzzy-trace theory and medical decisions by minors: Differences in reasoning between adolescents and adults. Journal of Medicine and Philosophy, 38(3), 268-282.

Reyna and Wilhelms try to help the audience on understanding the minor’s authority in making medical-based decisions. The writers have utilized fuzzy-trace theory to explain poignant socio divergences that interfere with the effectual determination of the medication to be given to a particular patient. Indeed, this article shows some risks such as deceit and errors can happen if the informed consent is issued by other people instead of the patient. Conversely, these inscribers hold that minor adults should be taken as an exception instead of presumption since accurate consenting depends on the capability of making a decision. Based on the above argument, there are possibilities that physicians need to consider both the case by Laura and her mother to get the accurate information.

• Hein, I.M., De Vries, M.C., Troost, P.W., Meynen, G., Van Goudoever, J.B., & Lindauer, R.J. (2015). Informed consent instead of assent is appropriate in children from the age of twelve: Policy implications of new findings on children’s competence to consent to clinical research. BMC Medical Ethics, 16.

This article is a research done to support that the informed consent should be given by the children above 12 years. The authors were motivated to conduct this study since the decisions regarding children with capacities of making choices were considered as a standardized assessment tool for giving treatment directives. However, many individuals were backing the argument that dual consent procedure was the best method of medication since it allowed both parents and children to offer their views. This article confirms that the application of the twofold compliant has therefore led to accuracy in treating minor adults. In consideration of writers’ stand, Laura and her mother information will be evaluated to acquire the accurate and error-free results.

• Spatz, E. S., Krumholz, H. M., & Moulton, B. W. (2016). The new era of informed consent: getting to a reasonable-patient standard through shared decision making. Jama, 315(19), 2063-2064.

This article aims at showing the importance of implementing shared decision making the procedure as a new era of informed approval. The authors were pressured to write this context because of the increased global scrutiny about allowing the patient to participate in making decisions regarding their treatments. The article concluded that the involvement of patients in determining the mode of medication to be applied to them act is ethical and legal. In this context, it is indicated that the court has abolished medical paternalism in various nations including the United Kingdom, thus, embracing the patient-based views. Concerning this article, it will be ethical and legal to ignore mother’s decision and accept the information given by Laura.

• Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, e20161485.

This article provides a comprehensive understanding about informed consent in the pediatric operation. Through reading this context, it is clear that the informed consent should be submitted by both parents and children hence ascertaining that all parties are equally represented in decision-making. However, the authors of this piece stress that children’s opinions should be involved in making choices about medication. The above method of making a decision is based on the temperament of informed consent, hence, ensuring that the children and adolescent are not ignored in the matters concerning their health. In connection with the argument in this article, the physicians will respect arguments by both Laura and her mother to avoid errors while providing treatment.

• Reynolds, S., Grant-Kels, J. M., & Bercovitch, L. (2017). How issues of autonomy and consent differ between children and adults: Kids are not just little people. Clinics in Dermatology.

The authors of this article focus on determining the way consent and autonomy issues differ amid adults and children differs. In this context, it is said that the decision making in medical practices involving adults sometimes appears as a straightforward practice about exchanging ideas, opinions, and information between patient and physicians. The writers argue that in cases of severe problems the informed consent will be issued after discussing with patient and parents. However, the guardian or parent cannot permit the operation without assent by the child. Based on this article, it will be legal and ethical to consider the agreed information given by both Laura and her mother.

• Bolt, I.L., & van Summeren, M.J. (2014). Competence assessment in minors, illustrated by the case of bariatric surgery for morbidly obese children. Best Practice & Research Clinical Gastroenterology, 28(2), 293-302.

The authors of this article focus on determining the competence of minors in making decisions about their treatments. This book indicates that the clinicians need to evaluate the aptitude of the children in making their choices. Indeed, the above action will ascertain that justice is practiced on kids who can express themselves logically. Otherwise, the writers have identified those minors are wanting to receive medication are unable to come up with the autonomous decision as compared to kids who are not willing to receive any treatment. Since Laura is accepting to receive medical attention, then it will be ethical and legal to involve her in filling the intake and informed consent form to thwart instances of submitting erroneous information to health officers.

Thesis Statement and an Outline of the Policy Memo

Thesis statement for this paper is the legal and ethical contradiction because of Laura’s mother filling wrong information in the intake and informed consent forms.

Outline of the Policy Memo

This case study is about Laura, a 16 years old girl, who wants a tooth removal service. For the physician to undertake this operation without causing pain, anesthesia needs to be injected into client’s gum to avoid throbbing. In usual cases, the patient is required to fill both intake and informed consent forms to help the dedicated physicians to determine the method which suitable for handling the presented evidence. The client, in this case, was accompanied by her mother who does not consult or involve the daughter due to being overconfident. As a result, Laura’s mother has, however, filling both intake and informed consent documents with original details hence failing to consider sensitive information, which only her daughter knew. After submitting the forms to the doctor and the process of administering anesthesia is about to start, Laura while sitting in a chair and tells the healthcare that she feels as if she is pregnant.
In typical cases, anesthesia is not supposed to be injected to expectant women since it can lead to more complication. For the information in the forms were already entered in the hospital system, this incidence has created confusion whether to proceed with the teeth removal procedure by ignoring Laura’s argument. On the other hand, the physician is in a shock since it will be unethical and illegal not to adhere to patient’s concerns. Indeed, Laura has 16 years, an indication that she is at adult minority level, hence, she is supposed to fill the informed consent form without being influenced by anyone including the parent. However, numerous legal and ethical implications will emanate from this case of differing information about a single patient.

Legal and Ethical Implications

a) Depletion of Shared Decision Making

According to Laura’s case, there are various legal and ethical implications need to be considered to resolve the existing confusion. For instance, the shared decision-making is amid the consideration which can help in handling the above issue. Indeed, the power to make medical choices were initially lying squarely in the physicians’ hand, but presently all interested parties are involved in determining the suitable course to be employed in a given scenario. Otherwise, the complex social alteration has emanated from acceptance of the opinion that clients need to know about their well-being, are informed about the treatment and diagnostic options as well as their probable benefits and risks. Currently, diverse individuals define the traditional medical exercises with the slogan “doctor knows everything.” It is recognized that sick people and their surrogates need to have freedom of making decisions, consulting fosters, and propose a medical intervention that they prefer or not. The decision-making authority or power appears to like a thing to be communicated by involved parties thus respecting the physician-surrogate and physician-patient relationship. The Laura’s case shows that family members and patient’s value can influence the healthcare choices, hence, the physicians will have to respect the autonomy, preferences, and rights of their surrogates and patients.

b) Disregarding of Ethics and Informed Consent

The principle of informed permission supports the aspect of respecting people by accurately and entirely offering information pertinent to exercising their rights of making a decision. The Laura’s case shows that various consent elements are not reverenced. First, the involved doctor may not have explained in understandable language nature or conditions and ailment where anesthesia cannot work. Moreover, it seems that Laura’s mother did not know the risks associated administration of this drug to a pregnant person and also she does not know other alternatives treatments that should be used. Moreover, both the physician and the parent have failed to take time in assessing Laura’s understanding of the information present in the informed consent form. In this case, the physician can only act ethically by providing patient with the freedom of having another type of medication without manipulation or coercion.

c) Quandary with the Concept of “Approval” by Proxy

While trying to adopt the notion of informed permission to pediatrics, a great number of people think that the child’s guardians and parents have the right to full authority to allow assent by proxy. However, several parents try to protect the best interests and welfare of their kids in consideration of the healthcare hence proxy approval appears to operate reasonably. On the other hand, the consent impression encompasses various ambiguities such as the confusion that emanated from errors made by Laura’s mother. In this case, consent should embody judgment concerning recommend intrusions, and more notably the assent should express personal desires of the client. For instance, the forms submitted by Laura’s mother were supposed to have own unique goals, beliefs, and the values of the patient.

d) Parental Shared Responsibility and Permission

The process of making decision riveting the wellbeing of young patients needs to flow from responsibility shared by parents and physicians. As a result, the practitioners must have informed consent from parents or guardians before instigating any medical intercession. An acquainted approval entails all the elements of standard notified permit as indicated by the rule of law. Typically, parental approval articulates the preeminent concerns of the child. In the view of the pluralistic community, it is easy to come across various philosophic, religious, cultural and social positions regarding child welfare as well as acceptable rearing behaviors. Similarly, the law grants patents with the extensive unrestricted power to raise their children through making choices on behalf of them. Moreover, the existence of child neglect and abusing the laws and guidelines clarifies that parents may sometimes contravene their compulsions towards their kids. Regarding this information, it is not clear, whether Laura’s mother has made a mistake intentionally to punish her daughter or if she is not aware that this girl is pregnant.

e) The Concept of Assent and Development of the Kid as a Person

The process of deciding the health care of adolescents and older children need to entail the patient’s consent and the participation of the physician as well as parents or guardians. However, the pediatricians must not necessarily consider children as independent, rational or decision makers, though they need to offer severe contemplations to every client’s developing capabilities for making a decision, including autonomy and rationality. When healthcare givers realize the significance of consent, they, therefore, empower kids to a level of their capacity. Moreover, there are various things to be done in scenarios where someone does not or should not solicit the opinion or agreement of the patients. First, there should be involvement of people in the discussion about their wellbeing may create trust and improved physician-patient interaction, and perhaps leads to the advancement of long-term healthiness results.

In the case of Laura, the consent should contain various elements. The approval must aid her to attain a developmental awareness concerning her future condition. The physicians should also explain to this client about the expectation of the treatment hence easing the understanding of medical operations. Moreover, healthcare givers must also explain to the patients the factors influencing her reaction including the probable pressure to accept or accept therapy. Furthermore, the doctor should also solicit an expression regarding the client’s eagerness to acknowledge proposed care. However, it should be noted that no single individual should implore patient’s opinions without intending to conduct the severe evaluation. In addition, in instances where the patients must receive the treatment despite opposing this idea, then the customer must be told about every fact without being deceived thus promoting trustworthiness and loyalty.

f) Informed Consent and Legal Emancipation

The traditional impression about informed consent visibly applies to patients, who have attained the majority legal age, apart from those considered incompetent. In this case, the law has established two settings where minors have exclusive power to come up with health care decisions. For instance, some children are said to be ‘emancipated’, hence, being taken as grown-ups in various cases. The liberated group is made up of self-supporting people and those not living at home; parent or pregnant women, married individuals, people in the military as well as those confirmed limitless by the court. Indeed, the authority of making a decision is given to people regardless of the parental involvement of some indigent persons having a capacity of making decisions. Moreover, the circumstances where minors are said to be partially or entirely emancipated are denoted by the case law and statute hence it may differ from a single region to the other.

g) Consent by Children

The kids around 16 years may be considered to have the aptitude to consent through proving that they can entirely understand decisions, which they are making. This aspect denotes that children should comprehend not only the therapeutic facet but also the ethical and moral elements too. For example, when a kid appears being not knowledgeable about consent, then a surrogate with parental responsibility can make choices on behalf of the child. This pronouncement can, however, be overridden in the court if they do not consider the best interests of the patient. Moreover, the guardian can still consent to a medication even in scenarios where the child defies. On the other hand, the court may cancel a refusal to permit offered by the kid where parents are not observant of the children’s wellbeing. This cancellation is witnessed in cases where the government is dealing with denominations failing to receive medications due to their religious beliefs (Hein, Troost, Broersma, De Vries, Daams & Lindauer, 2015).

What Need to Be Done to Ensure that Laura’s case is Solved in an Effective Way

Irrespective of the fact that Laura’s mother has made mistakes while filling the intake and informed consent form because of failing to enquire sufficient information, there are many alternatives for ensuring the health issue is solved in time. For instance, the doctor needs to carry out a pregnancy test to confirm whether Laura is expectant or not. The analysis will save time and avoid chances where the physician can deliver treatment based on assumption rather than having confidential details. On the other hand, both Laura and her mother can jointly fill other forms to ascertain that everything is correctly entered to avoid errors. Moreover, this girl has attained 16 years, and therefore she should be allowed freedom of choosing the type of treatment, which she prefers. The doctor can also help this girl by proposing the alternative method of removing the tooth or treating the problem.

References

Bolt, I.L., & van Summeren, M.J. (2014). Competence assessment in minors, illustrated by the case of bariatric surgery for morbidly obese children. Best Practice & Research Clinical Gastroenterology, 28(2), 293-302.

Coleman, D.L., & Rosoff, P.M. (2013). The legal authority of mature minors to consent to general medical treatment. Pediatrics, 131(4), 786-793.

Hein, I.M., De Vries, M.C., Troost, P.W., Meynen, G., Van Goudoever, J.B., & Lindauer, R.J. (2015). Informed consent instead of assent is appropriate in children from the age of twelve: Policy implications of new findings on children’s competence to consent to clinical research. BMC Medical Ethics, 16.

Hein, I.M., Troost, P.W., Broersma, A., De Vries, M.C., Daams, J. G., & Lindauer, R.J. (2015). Why is it hard to make progress in assessing children’s decision-making competence?. BMC Medical Ethics, 16(1), 1.

Katz, A.L., Webb, S.A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, e20161485.

Kinnersley, P., Phillips, K., Savage, K., Kelly, M.J., Farrell, E., Morgan, B., ... & Blazeby, J. (2013). Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. Cochrane Database Syst Rev, 2013, 7CD009445.

Parsapoor, A., Parsapoor, M.B., Rezaei, N., & Asghari, F. (2014). Autonomy of children and adolescents in consent to treatment: Ethical, jurisprudential and legal considerations. Iranian journal of Pediatrics, 24(3), 241.

Reynolds, S., Grant-Kels, J. M., & Bercovitch, L. (2017). How issues of autonomy and consent differ between children and adults: Kids are not just little people. Clinics in Dermatology.

Spatz, E.S., Krumholz, H.M., & Moulton, B.W. (2016). The new era of informed consent: Getting to a reasonable-patient standard through shared decision-making. Jama, 315(19), 2063-2064.

Wilhelms, E.A., & Reyna, V.F. (2013). Fuzzy trace theory and medical decisions by minors: Differences in reasoning between adolescents and adults. Journal of Medicine and Philosophy, 38(3), 268-282.