Canterbury v. Spence, Shared Decision-Making, and The Theory of Informed Consent
• Week 4: Tutorial Questions
Questions:
TQ 4.1: Canterbury v. Spence: The court observes that most courts have analyzed failure-to-disclose cases by looking at “whether it was the custom of physicians practicing in the community to make the particular disclosure to the patient.” Why does the court reject this standard? What standard does it adopt instead? What does the court mean when it says that “the scope of the standard is not subjective as to either the physician or the patient; it remains objective with due regard for the patient’s informational needs and with suitable leeway for the physician’s situation”?
TQ 4.2: Shared Decision-Making: What is “shared decision-making”? What are patient decision aids, and what role do they play in shared decision-making? What are some of the key barriers to the use of shared decision-making? What measures does Pope propose to increase the use of shared decision-making?
Instructions for responses to the Tutorial Questions are available on the Course Information page. For grading information, please see the Tutorial Question rubric in the Assessment Rubrics menu. •Week 4: Discussion Board Question 1
Questions:
DQ 4.1: Many people believe that there is an enormous gap between the theory of informed consent, which is designed to promote active patient participation in medical decision-making, and the realities of everyday medical practice, where many patients simply defer to whatever their health care providers propose, often with little reflection or discussion. Do you agree that there is such a gap? If so, why do you think it exists? Do you think it is problematic? What, if any, steps would you recommend to change the situation?
Instructions for responses to the Discussion Questions are available on the Course Information page. For grading information, please see the Discussion Question rubric in the Assessment Rubrics menu.
• Week 4: Discussion Board Question 2
Questions:
DQ 4.2: Under what circumstances, if any, should providers be required to tell patients about the provider’s receipt of consulting payments from pharmaceutical companies or medical device manufacturers? Would a patient ever be able to bring a successful informed consent case against a provider who fails to make such a disclosure? Are there potential downsides to requiring providers to disclose such information as part of the informed consent process?
Instructions for responses to the Discussion Questions are available on the Course Information page. For grading information, please see the Discussion Question rubric in the Assessment Rubrics menu.
•Activity 4: Designing an Informed Consent Process
You have been asked by a small medical practice to design a process for obtaining informed consent to prostate-specific antigen (PSA) testing. After reviewing this information, as well as any other relevant and authoritative sources you find on the Internet, please draft the following:
• An informed consent form to testing written to conform to the disclosure standard articulated in Canterbury. The form should be concise, easily understandable, and free of any non-essential information. • A one-page document containing links to at least two decision aids about the test (you can find numerous decision aids on the Internet), along with a one-paragraph description of how each decision aid works.
• A one-page cover letter to health care providers, which you will send out along with the two documents above, explaining the purpose of the documents and any other important information you believe providers should know in designing an effective informed consent process
For grading information, please see the Writing Activity rubric in the Assessment Rubrics menu.
Week 4: Tutorial Questions
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Week 4: Tutorial Questions
TQ 4.1: Canterbury v. Spence
Failure to disclose cases is an act of adopting the requirements of informed consent. According to video transcript, the court adopted a standard that would allow “ordinary citizens to understand it and regulate their conduct accordingly.” The court noted that some courts have held that the standard is whether the defendant acted as a reasonable physician would act given all relevant circumstances. The court notes that this is essentially the same as its new standard. However, this reasonable physician standard has never been applied consistently across all states. It was thought to be too vague and uncertain for jurors to apply (Spence v. Canterbury, 1972).
Based on the video transcript, the court means that the standard is objective to both physicians and patients. This means that physicians need to look at the generally available information, not just limited to their own experience. On the other hand, patients need to understand what is being told to them before getting a treatment (Spence v. Canterbury, 1972). So, the physician needs to act as a reasonable person with regard to what information is generally available about the condition of concern. For example, if most people know that it only takes 30 minutes for heroin to kill someone, then this will be part of the standard that a reasonable person would use in disclosing this kind of information about heroin use.
TQ 4.2: Shared Decision-Making
Shared decision making involves informed consent when making decisions. According to video transcript, for those unfamiliar with the term, shared decision-making is a way people work collaboratively with each other to decide what medical care they want. These decisions are made by discussing your health care needs and then coming up with the best options that meet those needs (Elston Lafata et al., 2016). Shared decision-making is typically used in cases where there are disagreements between professionals about what course of action should be taken for an individual’s health care. Medical professionals, including physicians and nurses, often discuss the treatment options with you to create one plan that suits everyone’s needs.
Patient decision aids (PDAs) are tools that help people make the most informed decisions in fields like medicine and dentistry. They can give people information about a condition, explain how their bodies work, and show alternative treatment options. As a result, patients will be able to make more informed decisions for themselves (Kujawski et al., 2019). People who want to participate in shared decision-making should consider registering with a patient decision aid that helps provide people with the right treatment options for their health care needs.
According to video transcript, the key barriers to the use of shared decision-making include lack of information, lack of trust in medical professionals, and lack of insurance coverage (Rehman, 2016). Pope proposes measures to decrease these barriers, such as improved patient education and improved means for obtaining health care.
DQ 4.1
I agree that there is such an enormous gap between the theory of informed consent. On the video transcript, the gap exists because the medical culture is one of hierarchy; if your physician thinks something is necessary, you don’t question it. Some might call this deference to authority (Parakh, 2017). If you don’t like the proposed treatment, you can go to another doctor who may have a different point of view.
I think this gap is problematic. While recommending, the first step is to ask the questions before you make any decisions. This means to stop automatically trusting your physician’s judgment. There are several sources of information that you should gather before you make any decisions. You can begin with Internet searches or even visits to medical libraries, then go to the various websites of doctors who specialize in various areas of health care (e.g., endocrinologists, pathologists) (Parakh, 2017). These resources will provide detailed information about diseases, treatments, and their outcomes.
DQ 4.2
The issue of providers’ receipt of consulting payments is a very important topic because when patients are aware of the situation, they are able to make an informed decision when it comes to their healthcare. In all communications with patients, the provider would have to disclose in writing that they have received consulting payments from pharmaceutical companies or medical device manufacturers in the past year (Parakh, 2017). They also must disclose if there is any potential conflict of interest between themselves and pharmaceutical companies or medical device manufacturers. If the answer is no, then no additional disclosure would be necessary.
Informed consent is a type of case brought against a healthcare provider in which a patient asserts that the provider failed to adequately inform the patient about a medical procedure, treatment, or diagnosis. As such, an informed consent case can be brought on behalf of an individual whose physician recommends a course of action that may not be in the best interest of their health or life (Parakh, 2017). The individual then brings suit against their physician. The particular legal theory behind this type of action is that the patient was not given sufficient information about their medical condition and how it would affect them if they followed through with certain recommended treatment options.
One of the potential downsides is that if patients are aware of these relationships, they may have more questions about what the provider will be doing during the procedure. The potential downside to this would be increasing the time it takes for a procedure, potentially endangering the patient’s life and healthcare workers (Parakh, 2017).
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