Showing posts with label informed consent. Show all posts
Showing posts with label informed consent. Show all posts
Friday, 31 January 2014
4th Workshop: Consent
The fourth and final meeting as part of the current RSE workshops project will take place on Wednesday 5th February. The theme will be consent (or authorisation, as it is in Scots law) and the schedule is as follows:
Paper 1. Ben Saunders (Stirling) ‘Should Willingness to Receive be Understood as Consent to Give?’
Paper 2. Barbara Neades (Napier) ‘Consent/Authorisation in Scottish Legislation’
Paper 3. Hugh McLachlan (Glasgow Caledonian) ‘Posthumous Organ Retrieval, Consent and Justification’
Paper 4. Henrietta Consolo (Glasgow) ‘Consent and Best Interests of the Patient in Controlled Donation after Circulatory Death’
Roundtable. What have we learned from the project as a whole? Future collaboration possibilities?
Thursday, 17 January 2013
Defeasible Refusals of Consent
It's a widely accepted view in medical ethics that doctors should not do anything to patients without their informed consent. (There are some exceptions, of course, for patients unable to consent, e.g. minors or the unconscious.) A patient's consent is not binding, because they cannot force a doctor to treat them, but their non-consent is, in the sense that if they refuse a treatment the doctor is not permitted to administer it.
Yesterday I was completing a reference form for a former student hoping to go to graduate study when I read this: "Please tick here if you do not consent for us to disclose the information provided in this reference, to the applicant. If requested by the individual to release this information, we will take your consent preference into account when considering all of the circumstances and deciding if it is appropriate."
It struck me as interesting that, in this case, an explicit refusal of consent was taken as something to be considered, but not as binding. Of course, what's at stake in the two cases (medical treatment and privacy) is different. Some universities do allow applicants to waive any right to see their references, but the referee's wish not to have their comments disclosed to the candidate is (in almost all circumstances) less important than someone's wish not to be operated on.
In the case of organ donation, someone's organs can (under current UK law/practice) be used without their consent, since their next of kin can make the decision after their death. Families rarely go against the recorded wishes of the deceased, where these are known, but since many people do not make their preferences known, it's inevitable that some will have their organs used though they would not have wanted this.
This is one reason why those who do not wish their organs to be used might support a switch to an opt-out donor system: though it imposes upon them the burden of registering their wishes, it allows them to record their objection (which arguably should then be binding, whatever the views of their next-of-kin).
Yesterday I was completing a reference form for a former student hoping to go to graduate study when I read this: "Please tick here if you do not consent for us to disclose the information provided in this reference, to the applicant. If requested by the individual to release this information, we will take your consent preference into account when considering all of the circumstances and deciding if it is appropriate."
It struck me as interesting that, in this case, an explicit refusal of consent was taken as something to be considered, but not as binding. Of course, what's at stake in the two cases (medical treatment and privacy) is different. Some universities do allow applicants to waive any right to see their references, but the referee's wish not to have their comments disclosed to the candidate is (in almost all circumstances) less important than someone's wish not to be operated on.
In the case of organ donation, someone's organs can (under current UK law/practice) be used without their consent, since their next of kin can make the decision after their death. Families rarely go against the recorded wishes of the deceased, where these are known, but since many people do not make their preferences known, it's inevitable that some will have their organs used though they would not have wanted this.
This is one reason why those who do not wish their organs to be used might support a switch to an opt-out donor system: though it imposes upon them the burden of registering their wishes, it allows them to record their objection (which arguably should then be binding, whatever the views of their next-of-kin).
Tuesday, 18 December 2012
Smoker's Lungs
A tragic story in the news today concerning a 27-year-old cystic fibrosis sufferer who died of lung cancer after being given a transplant from a smoker.
In this case, the family of the deceased are angry that she was not warned that these lungs came from a smoker and of the consequent risks. The Royal Brompton and Harefield NHS Foundation Trust seem to acknowledge this and apologise for not giving her the choice of whether to take these lungs or wait for a match with a non-smoker, though they do note that almost everyone given such a choice opts to take the first healthy match available rather than wait (the woman in question had already been waiting 18 months).
This, of course, raises issues regarding informed consent. It is a dogma of medical ethics that medical professionals should not do anything potentially harmful to patients without their informed consent. What it is for consent to count as 'informed' is a thorny issue, but it is clear that risks - such as those imposed here - should be explained to the patient, before the patient consents to proceed (or refuses).
Obviously the use of 'marginal' organs is less than ideal. Everyone, given the choice, would prefer young and healthy organs. However, according to statistics given in the BBC article, 40% of lung transplants involve lungs taken from a smoker. If all of these were routinely rejected as unsuitable, there would be fewer lungs available for transplant, resulting in longer waiting lists and more people dying on them.
One of the aims of my work on organ policy is to see how donation can be encouraged, in order to combat what I take to be a pressing moral problem. Increasing the supply of healthy lungs (and other organs) available for transplant could save lives. The policy challenge is to find measures that will be both effective and ethically sound. The aim of the workshops I'm organising next year is to explore some of the possibilities.
In this case, the family of the deceased are angry that she was not warned that these lungs came from a smoker and of the consequent risks. The Royal Brompton and Harefield NHS Foundation Trust seem to acknowledge this and apologise for not giving her the choice of whether to take these lungs or wait for a match with a non-smoker, though they do note that almost everyone given such a choice opts to take the first healthy match available rather than wait (the woman in question had already been waiting 18 months).
This, of course, raises issues regarding informed consent. It is a dogma of medical ethics that medical professionals should not do anything potentially harmful to patients without their informed consent. What it is for consent to count as 'informed' is a thorny issue, but it is clear that risks - such as those imposed here - should be explained to the patient, before the patient consents to proceed (or refuses).
Obviously the use of 'marginal' organs is less than ideal. Everyone, given the choice, would prefer young and healthy organs. However, according to statistics given in the BBC article, 40% of lung transplants involve lungs taken from a smoker. If all of these were routinely rejected as unsuitable, there would be fewer lungs available for transplant, resulting in longer waiting lists and more people dying on them.
One of the aims of my work on organ policy is to see how donation can be encouraged, in order to combat what I take to be a pressing moral problem. Increasing the supply of healthy lungs (and other organs) available for transplant could save lives. The policy challenge is to find measures that will be both effective and ethically sound. The aim of the workshops I'm organising next year is to explore some of the possibilities.
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