Whose Responsibility Is Informed Consent in the Patient at Risk for Postoperative Vision Loss Research Proposal

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Postoperative Vision Loss

Elements of an Informed Consent Form

Patients Who May be Unable to Make Healthcare Decisions

Recommendations for Decreasing POVL

Four Elements of Negligence

Prudent Behaviors in Medical Informed Consent

Cortical Blindness (Vision loss after…, 2009, ¶ 6).

CRAO: Central Retinal Artery Occlusion (Chang & Miller, 2005, Introduction section, ¶ 1).

IGT: Iowa Gambling Task (Northoff, 2006, p. 70).

Ischemic Optic Neuropathy (Vision loss after…, 2009, ¶ 6).

IOP: Intraocular Pressure (Gilbert, 2006, ¶ 4).

MacCAT-T: MacArthur Competence Assessment Tool (Northoff, 2006, p. 70).

NQF: National Quality Forum (Clarke, Johnston & Finley, 2007, p. 395).

OR: Operating Room (Clarke, Johnston & Finley, 2007, p. 396).

POION: Perioperative Ischemic Optic Neuropathy (Chang & Miller, 2005, Introduction section,

¶ 1).

POVL: Perioperative Visual Loss (Gilbert, 2006, ¶ 2).

RVO: Retinal Vascular Occlusion (Vision loss after…, 2009, ¶ 6).



"Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable in damages"

- Justice Benjamin Cardozo,

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(as cited in Paterick, Carson, Allen & Paterick, 2008, p. 313).


Research Proposal on Whose Responsibility Is Informed Consent in the Patient at Risk for Postoperative Vision Loss Assignment

Prior to the patient receiving medical care, the patient or an individual authorized to consent for the patient, must sign a consent form (Informed consent in anesthesia, 2010). Whether or not the patient who signed a consent form prior to a medical procedure was actually informed constitutes a critical, common concern in medical malpractice lawsuits. During the literature review for this study, which examines concerns related to informed consent, the researcher addresses the primary research question: Who is responsible for informed consent in regard to the patient at risk for postoperative vision loss? Sub-questions considered during the review of the literature include:

1. What is informed consent?

2. What is postoperative vision loss?

3. Who may be responsible for informed consent?

James Neill (2003) explains the goals of the literature review in the article, "How to write a literature review." Neil asserts that: "Understanding a body of professional literature is much like mapping and analyzing the geography of an unknown island..." (¶ 1). As the researcher explores the "island of knowledge" relating to the focus of the designated study, informed consent, key features of the formerly unfamiliar island typically materialize; for instance:

A clear answer to… [the study's] research question a good sense of what has been thoroughly investigated and in what areas useful new work might be done a broader understanding of the question as it relates to other, related areas of knowledge research hypotheses interesting, new questions (Neill, 2003)

According to Lawrence A. Machi, and Brenda T. McEvoy (2008) in Literature Review: Six Steps to Success, the following six steps to pick to model for the development of a literature review:

Step1: Select a topic.

Step 2: Search the literature.

Step 3: Develop the argument.

Step 4: Survey the literature.

Step 5: Critique the literature.

Step 6: Write the review (Machi & McEvoy, 2008, p. x).

Despite good intent, informed consent, according to Bonnie Booth (2008) in the article, "Informed consent at the heart of New York lawsuit," may not be, and in fact is seldom actually "informed." "According to AMA policy, physicians must honor the basic policy of informed consent 'unless a patient is unconscious or otherwise incapable of consenting, and harm from failure to treat is imminent' (Booth, ¶ 13). In their quest to create a consent form that veers away from legalese and medical terminology, which in turn confuses the average patient, researchers from both law and medicine have invested massive amounts of time and energy investigating informed consent procedures. In the U.S., informed consent is well grounded and common law (Informed consent…, 2010). Some states, however, currently define and set criteria for informed consent by statute, rather than common law (Booth).

Informed Content

Informed consent entails the process whereby a physician effectively communicates and explains in detail a procedure and the risk of the considered procedure to a patient prior to the procedure being performed. To complement the overall health of the patient, the physician needs to convey the complete process of the procedure, including risks, and educate the patient as to why the procedure is necessary. Dr. Colleen E. O'Leary (2006), Associate Professor and Interim Chair, Department of Anesthesiology, State University of New York Upstate Medical University, Syracuse, New York, asserts in the article, "Informed consent for anesthesia: Has the time come for a separate written consent document?," that the physician should present available alternative procedures and identify potential risks, as well as, probable benefits of the prospective alternatives.. In the surgical procedure, properly educating and informing the patient of the risks and benefits involved in the procedure, will given the patient a better understanding and help him make the decision to undergo the suggested medical intervention.

Prior to performing a procedure, a physician is ethically required when practicing medicine in all 50 states in specific statutes, to effectively communicate to a patient, basic component of any and every procedure, along with the risks and benefits of that procedure, before it is performed. Due to the myriad of information available on the internet, many contemporary patients are informed and ready to openly communicate with their physicians regarding medical procedures. O'Leary (2006) states: "Many doctors provide them [patients] with the information necessary for informed decision-making but do not adequately document the discussion" (¶ 2). When the doctor fails to properly document informed consent regarding a medical procedure and the unexpected complications occur, he may susceptible to legal litigation. According to the Joint Commission on Accreditation of Healthcare Organizations, the physician must documentation all elements of informed consent "in a form, progress notes or elsewhere in the record (Standard RI.2.4.0)" (¶ 5). In most instances, the patient signs a surgical consent form prior to the day of the procedure; typically during a preoperative appointment; often even before the patient meets their anesthesiologist.

A major challenge physicians confront regarding informed consent is that the physician or surgeon performing the procedure is not trained to discuss the risk anesthesia presents. As administering anesthesia is the responsibility of the anesthesiologist, O'Leary (2006) purports, "many anesthesiology practices rely on a sentence in the surgical consent document that may state something such as 'anesthesia' is required for the procedure, and there are associated risks & #8230;" (¶ 8). In some states, as physicians and surgeons do not want to be liable if complications occur, they will not allow a paragraph or even a single sentence regarding the word anesthesia in their particular consent form. O'Leary (2006) stresses that as professionals, anesthesiologists must invest time ensure their patients understand the anesthesia care plan.

Anesthesiologists have crusaded for a number of years for patients and surgeons to recognize and understand that their medical practice differs from that of their colleagues, a distinct part of the patient's medical procedure. O'Leary (2006) notes an old adage frequently taught in anesthesiology residency training programs purports when one does not write something down, some may argue that it did not occur. Some anesthesiologists, as well as physicians, contend the consent process should be separate so the patient may be educated and informed of the risks and benefits of both the anesthesia process and the surgical procedure itself.

It is imperative for medical professionals to understand the difference between securing the patient's signature on an informed consent form and actually effectively communicating pertinent, valuable information about a medical procedure to the patient. The article, "Informed consent in anesthesia," (2010) published by the American Association of Nurse Anesthetists, asserts that "often health providers assume that if they possess some evidence, such as a signed form, indicating that the patient has given consent, they have met the requirements of the law" (¶ 3). This presumption, albeit, proves false, and over time has birthed controversy in the medical profession. For medical professionals to prevent this "oversight," they could approach informed consent by focusing on effective communication and deliberately educating the patient about the upcoming medical procedure.

The patient cannot make a knowledgeable decision about a medical procedure unless the medical professional has communicated precise, straightforward, understandable information about the procedure. "By definition, the concept of informed consent implies that the patient has elected to have or forgo a medical or surgical procedure after having been provided with sufficient information to make an informed decision" (Informed consent…, 2010, ¶ 4). Because patients differ in levels of education, as well as factors such as culture and language, all medical professionals cannot know for certain whether or not a patient thoroughly understands the informed consent process. Consequently, physicians must make the informed consent process as clear and easy to understand as possible.

If the informed consent process ultimately turns in to a legal battle, medical professionals must present repute evidence proving the informed consent process. When the court determines evidence to be intangible or weak, the legal battle or dispute will focus… [END OF PREVIEW] . . . READ MORE

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