Informed Consent in Dementia

Consent to treatment constitutes the proposition that an individual must grant permission before receiving any examination, test or medical care. This should be done based on a clinician’s explanation. The procedure often involves the health care giver engages the patient in a discussion regarding the nature of the proposed treatment, risks, benefits, harms, consequences and other alternatives available (Mayberry and  Mayberry, 2013). Informed consent is an essential concept in health care. The procedure of informed patient is often taken as a safety issue for a patient from various perspectives. In the utmost, undertaking a process of a patient in the absence of their consent has been regarded by the law as the battery. Informed consent can also have a direct connection with the patient protection in that in the event of its success; it opens up a discussion between the provider and the patient allowing the patients to get clarification on the procedure and can in the least theoretically assist to prevent medical errors. Sometimes, individuals with dementia decline to receive their prescribed medicine. This refusal can be because the medicine tastes unpleasant, it is hard to swallow or has side effects like nausea. It is critical not to presume that the individual is merely “difficult”. In the event of such a situation, one should inform the person who prescribes the treatment. The prescriber will decide the capacity of the patient to choose to refuse the medicine. If the patient lacks the ability, then the prescriber can opt to base on their best interests. When deciding, it is recommended that the prescriber discusses with the patient’s care givers and relatives as well as other experts involved in the patient’s care (Berg & Appelbaum, 2001). If welfare or a health attorney has been organized, the attorney will be left to decide by the assistance of the prescriber. If the decision is that using medication is the safest option, then the medicine should be given using the least restrictive method available. Sometimes, taking medicine in a different form can work better than swallowing it. For instance, some painkiller and dementia drug is in the shape of oral solution or patch. The last resort may require that the drug is hidden in the patient’s drink or food. Nonetheless, this ‘covert medication’ may affect the absorption of the medicine, and must only be performed with written permission from the pharmacist, consultant of the individual’s GP (Mayberry and Mayberry, 2013). This paper aims at discussing some of the approaches to be used in addressing the issues of consent and client’s refusal on prescribed medicine in dementia.

Manage Procedures of Determining Ability and   Ensuring Informed Consent 

Medical ethics and the law require doctors to make sure that their patients give consent before receiving treatment. Authentic, informed consent can be premised upon the disclosure of proper information to a capable patient who is allowed to choose voluntarily. In the absence of competence in the patients to decide about treatment, alternative decision makers should be sought. Therefore, the resolution of whether individuals have the capacity is necessary for striking an appropriate balance between honoring the independence of people who are competent to make informed decisions and safeguard patients with cognitive impairment. Notwithstanding the significance of the evaluation of the patients’ capacity by medical practitioners and the occurrence of impaired competence among individuals, data recommends that the conducting of capacity assessment is usually suboptimal. Specialists are regularly not aware of the person’s incompetence for making decisions. When incompetence is suspected, medical practitioners may not be aware of the standard to use (Guido, 2010). Consequently, their assessments may not include mention of the applicable criteria or may fail to use them particularly to decisions regarding treatment.

The exercise of diagnostic classifications can be mistaken for determination of competence. For instance, a diagnosis of a psychotic disorder or dementia may be assumed incorrectly to show incapacity. In one research, five medical practitioners analyzing video tapes of competence evaluation and giving rates to the capacity of individuals obtained a rate of consensus that chance was the best (kappa statistic).Even though the diagnosis of incompetence for making decisions in people is determined partly by a proper level of suspicion by specialists, advancement in the undertaking of competence assessments themselves need clarification of the relevant criteria and the application of a systematic way to evaluate. Legal standards for competence in making decisions for treatment consent differ to some extent across jurisdictions, however generally they represent the capacities to convey an option, to comprehend the applicable information, to acknowledge the medical outcomes of the condition and to think about the choices of treatment.

The extent of impairment that makes an individual incapacitated to make decisions about treatment should preferably represent a societal judgment regarding the proper balance between safeguarding the individual, from the outcome of an adverse decision and respecting the person’s independence. When specialists undertake capacity evaluations, they should try to strike a similar balance that would present if the law in the jurisdiction ruled the case. Respectively, the assumption inherent to the current democracy is that vast majority of individuals are competent in decision making. Therefore, only persons who are impaired that appear below the performance curve can be regarded incompetence. Practically, the rigorous standards of the evaluation used differ directly with the quality of the probable outcomes of decisions of the patients. Even though some analysts oppose this approach of “sliding scale,” it is reasonable from a perspective of policy. However, according to judgments of the majority, it represents how the law handles these cases. In the light of the requirement of capacity for authentic, informed consent, the evaluation of the individual’s competence to decision-making is an inherent feature of every medical practitioners-patient interaction (Thomas-Anttila, 2015).

Often, the evaluation will be implied, because when there is no reason to doubt a person’s competence to make decisions the assumption of capacity remains. When an implied capacity assessment is needed, the medical practitioner should know the applicable criteria and should endeavor to apply structure ways of evaluation. In a single set of research, merely giving specialists particular legal directives to guide their judgments improved communication agreement. Another group of researchers discovered that requesting nurses and technicians to apply a systematic set of queries for capacity evaluation resulted in an elevated rate of consensus with judgment from experts. The published set of questions with proper face validity can be easily accessed, and they are recommended for use in guiding clinical evaluations. Any medical specialist who knows the applicable criteria should successfully evaluate the competence of a patient. Treating professionals may be advantaged in being more familiar with the individual and the available options of treatment. The psychiatric dialogue may assist in unusually severe cases or the presence of mental illness (Mayberry & Mayberry, 2003). There is an underlying instrument to screen individuals with impaired competence would help in the identification of individuals in need of more detailed evaluation. However, currently the search a quick neuropsychological screening tool has not been successful. In an attempt to standardize more and therefore improve the validity and reliability of capacity evaluations, many more formal assessment tools have been created. The MacArthur Competence Assessment Tool for Treatment is one of the most popularly used tools (Sharp, 2015).

The instrument is a structured interview, which unlike numerous other assessment tools, combines information particular to a specific patient’s situation of decision making. Quantitative scores are produced for the entire four criteria connected to the capacity of making a decision. However, assessors must combine the outcomes with other information to attain a judgment about capacity. The high interrater consensus on such scores reported so far by many study groups is often greater than the outcomes in surveys of systematic clinical evaluation. The MacArthur trial lasts about 20 minutes to give and score.

Communicating in a Way that Positively Places the Individual with dementia

Refusing treatment leads to high likelihoods of adverse problems that should be examined (Kusz and Sheppard, 2016).. The individual might decline to ingest due to the unpleasant side effects which they could not have managed to illustrate verbally. Similarly, it could be because the treatment that has been prescribed is not suitable for them and makes them feel uncomfortable. For instance, a lot of individuals find the impact of Patient of dementia might also decline to ingest their drugs that have been prescribed due to the lack of understanding, or they forget its uses. It is significant to provide understandable clarification using symbols and words if required that the individual can comprehend-every time their treatment is provided. An individual might be given various pills and only be able to ingest every pill following a reminder of its use (Coulter, 2011). If a dementia patient does not entirely trust the medical practitioner who is giving the treatment, they are most likely to take it. Once again, therefore, this outlines the requirement to developing trusting associations with every individual with dementia.            

People are not born with the expertise of communicating with patients of dementia. However, it is possible to learn. Enhancing one’s communication skills can assist in caregiving more manageable and can significantly increase of the relationship with the patient (Kusz and Sheppard, 2016). Excellent skills of communication can also improve one’s capacity to deal with problematic behavior that one may encounter during the care for patients with dementia. It is recommended that a health practitioner lays a positive mood for communication. One’s body language and attitude convey one’s thoughts and feelings more powerfully, unlike words. Putting a positive atmosphere can be achieved by discussing with the patient respectfully and pleasantly. Use of physical touch, the tone of voice and facial expressions assist going communicating a message and indicates feelings of affection. Secondly, it is highly recommended to get an individual’s attention by minimizing noise and distractions. This procedure may involve moving to quieter surroundings, shutting the door, closing curtains or turning off the radio. Before any discussion, it suggested that one get the patients attention by addressing them by their name and introducing themselves. One can also use non-verbal language to treat the patient. Messages directed to the patient should be stated using simple sentences and words. Speaking distinctly, slowly and in a reassuring tone also helps. One should avoid raising their voice louder or higher, rather pitch the voice lower and if there is still lack of understanding initially, repeat the same question or words. Patients should be asked answerable questions. Alternatively, the patient can be provided with visual cues and to help clarify the issues. Patients with dementia need a lot of patience especially when they are struggling to answer. In such a case a nurse can suggest words for them or just inform them that it is ok. It is recommended to apply humor whenever possible even though not when the patient is unwilling (Kusz, et al, 2016).

Enhanced Clinical Decision-Making Partnerships to Prevent Negative Effects of Stigmatization and Discrimination                 

Patients with dementia need to live with the combination of effects of dementia plus negative reactions to the symptoms and the diagnosis of the disease as well as self-stigmatization. Also, discrimination of age also acts a factor because dementia is the condition that appears in later stages of life. Hence, age plays contributes towards accentuating the role of stigma. In correspondence with all public health strategies, initiatives to decrease stigma and stigmatization should be founded on several decisions. The case of dementia case requires the extent of including mental disorders both implicitly and explicitly. Hopefully, this decision can be determined by the current evidence and ongoing work performed by actors in the program. Nonetheless, it appears that decision-making can also represent those who make the decision. Conventionally, anti-stigma initiatives were presented by remarkable participation by bodies of psychiatric professionals.

However modern enterprises have more management form mental health charities and support groups. These organizations have usually recognized mental health experts as one source of stigmatization and wonder whether they can credibly lead programs of anti-stigma. Another likely significant impact on credibility and decision-making is the base for funding the program. For instance, the involvement of pharmaceutical company can be viewed as a self-interested try to increase the selling of psychotropic drugs due to more help-seeking, upon which stigma affects negatively. Funding from government may be seen as influencing the option of methods or choices for an initiative. Anti-stigma interventions can be classified based on protest, contact, and education. Contact and teaching have been confirmed to be the most popular. Nonetheless, approaches of education differ widely based on the information they propose to communicate.

For instance, programs on literacy on mental health are aimed to stimulate helping behaviors, improve attitudes and further knowledge of problems of mental health (Kusz, and Sheppard, 2016). Rights-based programs concentrate on legal rights of dementia and mental health patients. Initial anti-stigma attempts usually used educational approaches. For instance, in 1950 an organization by the name Cumming and Cumming in Canada tried to minimize stigma by offering education on mental health through group films and discussions. Strategies for health experts usually depend on educational approaches. Later on, the employment of intergroup has grown, particularly after the 2012 meta-analysis by Corrigan and colleagues which outlined its efficiency (Kusz, and Sheppard, 2016)

Conclusion                 

The process of informed consent is necessary for care practitioners and patients regarding the nature of recommended medication and should involve discussion on risks, harms, consequences, as well as alternatives, was to the treatment. Even though further evidence is required on the probable particular relationship between patient safety and informed consent, research has indicated that advanced interaction between patients and practitioners results in lesser rates of claims of malpractice, minimal medical errors and enhanced patient results. Efficient, informed consent procedure has been more strongly connected to satisfaction in patients. In spite its significance, many types of research have shown that practically, the process of informed consent is usually not complete and patient comprehension and recall of the dialogue is often little. Dementia patients who have cognitive dysfunction, of the minority race, less educated and old are especially susceptible to the process of informed consent. Several approaches have been suggested for enhancing the process of informed consent. It is highly recommended to communicate in a Way that Positively Places the Individual with dementia. Also, increased clinical decision-making partnerships prevent adverse effects of stigmatization and discrimination

References

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Thomas-Anttila, K. (2015). Confidentiality and Consent Issues in Psychotherapy Case Reports: The Wolf Man, Gloria and Jeremy. British Journal Of Psychotherapy, 31(3), 360-375. Retrieved on September 10 2017 from http://dx.doi.org/10.1111/bjp.12157