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Highlights
Informed consent is the core principle of modern medical practice.
In some very limited circumstances, care can be provided without consent.
Health care practitioners must disclose conflicts of interest that might affect their clinical judgment.
There are special laws governing consent for minors and incompetents.
Patients have the right to refuse medical care, even when it means they will die.
Patients do not have a right to improper care or assisted suicide.
Introduction
Battery-No Consent
Exceptions To The Requirement Of Consent
The Emergency Exception
When Does the Emergency Exception Apply?
Children in the Emergency Room
Refusal of Care
Legally Mandated Treatment
The Therapeutic Exception
Informed Consent
Social Trends behind Informed Consent
Technology-Oriented Medicine
The Demise of Paternalism
Changing Values
Legal Standards for Informed Consent
Who Must Get Consent?
The Community Standard
Fraud in Consent
The Uncertainty of the Community Standard
Reasonable-Person Standard
Alternative Treatments
Statutory Disclosure Standards
Fraud
The Commonsense Approach
Knowable Risks
Unknowable Risks
Voluntariness
Public Policy
Medically Unnecessary Procedures
Duty to Inform of HIV
Professional Standard
Reasonable-Patient Standard
The Medical Value of Informed Consent
The Patient's Expectations
Conflicts Of Interest And Informed Consent
Financial Conflicts of Interest
Treating Family Members
Hospitals
Laboratories
Sexual Relationships with Patients
Consent For Minors
Documenting Who Can Consent for Your Patients
Special Circumstances
Guardians
Conflict between Parents
Conflicts between Parents and Children
Statutory Right To Treat Minors
Emancipated Minors
Interests of the Child versus the Parents
Religious Objections to Medical Care
Specific Types of Care
Consent For Medical Research
International Codes
The Nuremberg Code
World Medical Association
Consent under the International Codes
HHS Regulations on Protecting Human Subjects
General Requirements for Informed Consent22
Documenting Consent
The Form of the Documentation
Blanket Consent Forms
Treatment-Specific Consent Forms
Patient-Specific Consent Forms
Non-English Speakers
Illiterate Patients
Documenting the Oral Consent
Proxy Consent
Power of Attorney To Consent to Medical Care
Conflicts of Interest
Limitations
Guardianships
Establishing the Authority of a Guardian
Emergency Guardianships
Minors
Adults
The Interim until the Judge Rules
Refusal Of Care And Termination Of Life Support
Who Are the Stakeholders?
Patients' Interests
Physicians' Interests
Hospitals
Families
Society's Interests
The Cruzan Case
The Missouri Supreme Court Ruling
The U.S. Supreme Court's Ruling
The Persistent Vegetative State
Living with Cruzan
Formalizing the Patient's Wishes
The Duty To Counsel
Complying with a Patient's Refusal of Care
The Role of Courts
Following the Patient's Wishes
Judicial Intervention
The Simple Cases
Living Wills in the Emergency Room
The Impact of Cruzan
The Drawbacks of Substituted Consent
The Problem of Relatives
Assisted Suicide
History of Suicide Law
Physician-Assisted Suicide as a Constitutional Right
Right to Pain Relief
References
Suggested Readings
General Consent Issues
Impaired or Mentally Ill Patients
Research
Exhibit 9-1 World Medical Association Recommendations For Clinical Research
I. Basic Principles
II. Clinical Research Combined with Professional Care
III. Nontherapeutic Clinical Research
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