Thursday, October 17, 2013

Medical Ethics – Challenge with Consent

Medical Ethics – Challenge with Consent

All segments of the medical service space require consent; there are statutes that arrest one’s state of “competency” and permit treatment without consent – some draconian - to be discussed later. There are even provisions for people to be treated absent their knowledge and this is determined as appropriate, in some cases by a committee. Of course, as one who treasures choice, consent in the medical service space, or any space, is paramount – consent is the substrate of choice. For those of us lucky enough to have a “significant other” personal relations are oft times referred to as “love making”, the only component that separates “love making” from rape is consent. I offer this metaphor to sharpen the reader’s attention to the gravity of this discourse; this is much more than theoretical chit chat, this discussion brings resolution to the fact that “consent” & personal choice are one in the same, and when, by force, or deception, choice is removed people are, as the rape victim, disempowered and violated.

The only effective means to garner consent is to ask “is it ok to do this” and then to ensure that if the person answers in the affirmative they understand what they are agreeing to. There is no such thing as implied consent, people in the medical profession use the term “implied consent”. “Implied Consent” is loosely determined by deducting an action or verbiage as parallel “enough” that if the subject could provide consent they would. The Challenge with “Implied Consent” is that practitioners unable to garner consent think they need it, so they “over interpret” information, or they enter the process with confirmation bias as their companion, or the assumption of consent fails to adjust for a variance in risk and treatment – he takes Aspirin so Oxycontin is okay. The other challenge with implied consent is that inherent in implied consent is the absent of explicit discourse, so the subject is absent any knowledge; this grossly under rates the capacity of the lay person to manage or understand, and denotes a professional arrogance on the part of the practitioner. Implied consent can have a person exposed to a drug absent knowledge of what they are being exposed to, this practice is fraught with risk for any number of reasons – common sense will fill in the blanks.

Finally, there is the removal of the requirement to get consent – by way of example – the BC Mental Health Act. grants Doctors the power to deem someone mentally ill and incarcerate them. There are a host of ills with this specific act and discourse is outside the scope of this document, however, it suffice to say that when government action interrupts a person’s state of liberty, that judicial review should be commensurate with the “sentence” administered – now we have lay people deciding what defines “competency”, this reality is more than unethical, it flouts years of Canadian Jurisprudence.   

Consent is also a moving target; consent today can change to consent tomorrow or vise versa. So consent given ten years ago is no longer valid, as time passes circumstance can change – people learn more, people become more evolved. The critical element in consent is full disclosure of actions taken and ongoing assurance that the subject is fully informed and has understanding.

The base point of contemplation in matters related to consent is – make it explicit.       
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