Patients Bill of Rights
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In 1973 the American Hospital Association approved a statement called the Patient’s Bill of Rights. It was revised in October 1992. Patient rights were developed with the belief that hospitals and health-care institutions would support these rights with the goal of delivering effective client care. In 2003 the Patient’s Bill of Rights was replaced by the Patient Care Partnership. These standards were derived from the ethical principle of autonomy. This document may be found at www .aha.org/advocacy-issues/communicatingpts/pt -care-partnership.shtml.
Informed Consent Informed consent is a legal document in all 50 states. It requires physicians to divulge the benefits, risks, and alternatives to a suggested treatment, nontreatment, or procedure. It allows for fully informed, rational persons to be involved in choices about their health care (Marr, 2003).
Without consent, many of the procedures per- formed on clients in a health-care setting may be considered battery or unwarranted touching. When clients consent to treatment, they give health-care personnel the right to deliver care and perform specific treatments without fear of prosecution. Although physicians are responsible for obtaining informed consent, nurses often find themselves involved in the process.
It is the physician’s responsibility to give infor- mation to a client about a specific treatment or medical intervention (Giese v. Stice, 1997). While the nurse may witness the signature of a patient for a procedure, or surgery, the nurse should not be providing the details such as the benefits, risk, or possible outcomes. The individual institution is not responsible for obtaining the informed consent unless (1) the physician or practitioner is employed by the institution or (2) the institution was aware or should have been aware of the lack of informed consent and did not act on this fact (Guido, 2001). Some institutions require the physician or indepen- dent practitioner to obtain his or her own informed consent by obtaining the client’s signature at the time the explanation for treatment is given.
Although some nurses may believe that they only need to obtain the client’s signature on the informed consent document, nursing professionals have a larger responsibility in evaluating a client’s
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chapter 3 ■ Nursing Practice and the Law 35 ability to give informed consent. The nurse’s role is to: (a) act as the patient’s advocate, (b) protect the patient’s dignity, (c) identify any fears, and (d) determine the patient’s level of understanding and approval of the proposed care.
Every client brings a different and unique response depending on his or her personality, level of education, emotions, and cognitive status. A good practice is to ask a client to restate the infor- mation offered. This helps confirm that the client has received an appropriate amount of information and has understood it. The nurse is obliged to report any concerns about the client’s understand- ing regarding what he or she has been told, or any concerns about the client’s ability to make decisions.
The informed consent form should contain all the possible negative outcomes as well as the posi- tive ones. The following are some criteria to help ensure that a client has given an informed consent (Berman & Snyder, 2012):
■ A mentally competent adult has voluntarily given the consent.
■ The client understands exactly to what he or she is consenting.
■ The consent includes the risks involved in the procedure, alternative treatments that may be available, and the possible result if the treatment is refused.
■ The consent is written. ■ A minor’s parent or guardian usually gives
consent for treatment.
Ideally, a nurse should be present when the health- care provider who is performing the treatment, surgery, or procedure is explaining the benefits and risks to the client.
To be able to give informed consent, the client must be fully informed. Clients have the right to refuse treatment, and nurses must respect this right. If a client refuses the recommended treatment, he or she must be informed of the possible conse- quences of this decision.
Implied consent occurs when consent is assumed. This may be an issue in an emergency when an individual is unable to give consent, as in the fol- lowing scenario:
An elderly woman is involved in a car accident on a major highway. The paramedics called to the scene
f ind her unresponsive and in acute respiratory dis- tress; her vital signs are unstable. The paramedics immediately intubate her and begin treating her cardiac dysrhythmias. Because she is unconscious and unable to give verbal consent, there is an implied consent for treatment.