Consent, Capacity, and Jehovah’s Witnesses
Following is a video created by British medical students, who are often quizzed on specific clinical scenarios as part of their interview process:
A patient who is pregnant and at term comes in and needs emergency surgery, initially consents, but then withdraws consent due to fear of needles.
Consent in adults – only valid if it is informed, voluntary, and competent
Patient T – young woman who gets in a car crash and needs an urgent blood transfusion, which she consents to, however, after mom pressures her, the patient withdraws her consent for the transfusion; the withdrawal of consent deemed invalid as done under undue pressure from her mom.
Nadine Montgomery – Baby Sam had shoulder dystocia, leads to baby getting stuck in the birth canal and was deprived of oxygen for 10 minutes and thus had cerebral palsy, a permanent disability. Should she have been informed of this risk? Informed consent = What would a reasonable patient in that situation want to know (pros/cons, benefits/risks)?
Consent needs to be from a patient who is competent. The patient has to understand the decision they’re making, they have to be able to retain the information, they need to be able to weigh the risks vs benefits, and communicate their consent or lack of consent.
What happens with children?In the UK, patients who are 16 or 17 can consent but they cannot refuse if their parents are giving consent (their parents can override their refusal).
Can minors consent?
In the US, laws vary from state to state, but certain groups can consent or be given treatment, including emancipated minors, mature minors, minors with specific health conditions [STDs, sexual abuse], and minors needing emergency treatment where the parent can’t be reached:
https://www.americannursetoday.com/what-you-must-know-about-minors-and-informed-consent/
Listen to this NPR podcast on whether a teenager can be forced to receive chemotherapy:
What about a patient who lacks capacity but needs emergent treatment?
Check for a valid advanced directive regarding life-saving treatment. If that doesn’t exist, check for a Healthcare Power of Attorney (the U.S. version of a Health and Wellbeing Lasting Power of Attorney). If neither of those exist, then the physicians and entire team act in the patient’s best interests. That includes talking to friends and family to help determine a patient’s preference taking their religious and cultural preferences into consideration before making the decision with the patient’s best interests in mind.
References
Abdaal, A. (2017, December 21). Consent, Capacity, and Jehovah’s Witnesses - Medical Ethics & Law for interviews. Retrieved from https://www.youtube.com/watch?v=iGeDiXtJTRs
Smith, MH. (2007, May). What you must know about minors and informed consent. Retrieved from https://www.americannursetoday.com/what-you-must-know-about-minors-and-informed-consent/
Nalpathanchil, L. (2015, January 8). Can Connecticut Force a Teenage Girl to Undergo Chemotherapy? Retrieved from https://www.npr.org/sections/health-shots/2015/01/08/375659085/can-connecticut-force-a-teenage-girl-to-undergo-chemotherapy