Posted: May 1st, 2025

Health & Medical Question

Unit powerpoint with Elizabeth Example uploaded. Case 14(pages 64-67) and Case 16(pages 74-78) uploaded Please respond to the 3 prompts (1-3) below in your assignment submission for this unit. All parts of the submission can be included in one document:

1. Review Case 14 (Stand). In 250-300 words, answer the following question: In terms of decision-making capacity, how do you feel about Tim’s decision? What factors can you identify that may have resulted in his decision? Who were other stakeholders that his decision impacted? Was Tim the best person to make decisions regarding his care? (no plagiarism or AI)
2. Review Case 16 (The Prick). In 250-300 words, answer the following question: Considering the minimal harm and potential benefits, was the method of informed consent ethically acceptable? What factors do you think influenced the provider to seek consent? If an earlier conversation had occurred, what information pertaining to the prick should have been shared. (no plagiarism or AI)
3. Using an AI platform, create and submit a medical consent form for a person like Elizabeth in our lecture case example who has a 3rd grade reading level and identy how it might differ from the form I have attached. The comparison should be 200-250 words.
4. Readings down below will assist as well
5. Chapter 42 — Assesssment of Decision Making Capacity in Zollman, F. (2022). Manual of Traumatic Brain Injury : Assessment and Management (3rd ed.). Springer Publishing Company. https://ebookcentral-proquest-com.proxy.cc.uic.edu/lib/uic/reader.action?docID=6677919&ppg=461
6. Chapter 3 — Informed Consent in Lo, B. (2013). Resolving Ethical Dilemmas: A Guide for Clinicians. Philadelphia: Lippincott Williams & Wilkins (The entire book is available for free here—https://i-share-uic.primo.exlibrisgroup.com/permalink/01CARLI_UIC/1k7iidj/alma99494781281405897).

What will we cover?
• Autonomy demands veracity(honesty) and
fidelity( promise-keeping) in clinical
encounters and research. Individual
autonomy may wax and wane based upon
time and intellectual capacity to understand
and integrate information.
• We must talk about:
• Assessing Decision –making capacity
• If a person cannot make decision for
themselves, who should?
• Informed Consent
•
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© E. Swirsky
© Ann Jackson 102023
Key words associated with topic:
Personal and professional values,
moral distress, moral courage, ethical
decision making, autonomy,
beneficence, nonmalefience, justice,
capacity,competency, surrogate
What is a person’s capacity and how does that relate to decision
making?
© E. Swirsky
Capacity is a medical term that refers to a patient’s functional ability to
make decisions regarding their healthcare and provide informed
consent for treatment.
Competency is a concept that refers to the legal decision-making
status of a patient, which is formally determined by a court of law.
Surrogate is a health care decision maker identified by the provider if it
is determined that the patient lacks capacity and has not designated an
alternative decision-maker.
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© Ann Jackson 102023
Here’s a short video that helps illustrate capacity in a
person?
MCA – Mental Capacity Assessment – YouTube
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© Ann Jackson 102023
Our Case
Case Example:
Elizabeth is a vibrant, out going 32-year-oldwho
self identifies as female who was diagnosed with
Downs syndrome soon after birth. Elizabeth lives
in an apartment with her older sister, she works
as a Pre-School teacher’s Aide and is actively
involved in social activities at her church and
with friends she met at school and during her
training.
Recently, Elizabeth told her sister, Margo that
she had a boy friend and wanted to have sex
with him. Margo, tried for weeks to keep the
couple apart and convince Elizabeth that it would
be too scary and might not be a good idea.
Elizabeth has continued to insist that she has the
right to make her own decisions. Margo agrees
and she and Elizabeth go to see Dr. Purez, their
family doctor.
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© Ann Jackson 102023
In the face of the situation described in the case
Does Elizabeth
have capacity to
decide to have sex
or not?
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© Ann Jackson 102023
Who is legally
responsible for
Elizabeth’s actions
and decisions?
Does Elizabeth
need a surrogate to
make social, or
healthcare
decisions for her?
What is a person’s capacity and how does that relate to decision
making?
Capacity is a medical term that refers to a patient’s functional ability to
make decisions regarding their healthcare and provide informed
consent for treatment.
Competency is a concept that refers to the legal decision-making
status of a patient, which is formally determined by a court of law.
Surrogate is a health care decision maker identified by the provider if it
is determined that the patient lacks capacity and has not designated an
alternative decision-maker.
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© Ann Jackson 102023
Let’s lean in: Fundamentals of Decision-making capacity
Health care decision-making requires a patient’s abilities to understand relevant information,
appreciate the consequences of the situation, reason through treatment decisions, and
communicate choices.
It is presumed that every adult patient has capacity unless proven otherwise.
Patients with decision-making capacity can act autonomously and provide informed consent for or
refuse medical interventions.
Decisional capacity is not static.
© E. Swirsky
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© Ann Jackson 102023
The Essence of Capacity
Capacity involves the patient’s ability to decide
in any given situation.
We define ”rational” as being sensible to our
way of thinking.
First, the patient must understand the situation
to make an informed decision.
We use the idea that most people would want
the treatment as a criteria.
Determining patient’s understanding level may
be difficult in situations which can lead to end
of life.
Patients who make decisions based on facts
and logic appear to have capacity.
If the decisions does not logically flow from the
facts, we see the patient as lacking capacity.
McFarland, D. C., Blackler, L., Hlubocky, F. J., Saracino, R., Masciale, J., Chin, M., Alici, Y., & Voigt, L.
(2020). Decisional Capacity Determination In Patients With Cancer. Oncology (Williston Park,
N.Y.), 34(6), 203–210
Rodin, M. B., & Mohile, S. G. (2008). Assessing decisional capacity in the elderly. Seminars in
oncology, 35(6), 625–632. https://doi.org/10.1053/j.seminoncol.2008.08.006
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© Ann Jackson 102023
Assessing Capacity
There is no one universally accepted way to
assess patients’ decisional capacity.
Patients should not be deemed to be
incompetent based solely on their diagnosis or
condition.
Assessment of decisional capacity is decisionspecific.
It is generally accepted that capacity should be
assessed on a sliding scale.
© E. Swirsky
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© Ann Jackson 102023
10 Myths about Capacity
Ten Myths About Capacity
1.Decision-making capacity = competency.
2.Against medical advice = lack of decision-making capacity.
3.There’s no need to assess decision-making capacity unless a patient goes against
medical advice.
4.Decision-making capacity is all or nothing.
5.Cognitive impairment = no decision- making capacity.
6.Lack of decision-making capacity is permanent.
7.Patients who have not been given relevant information about their condition can
lack decision-making capacity.
8.All patients with certain psychiatric disorders lack decision-making capacity.
9.All institutionalized patients lack decision-making capacity.
10.Only psychiatrists and psychologists can assess decision-making capacity.
Source: Ganzini L, Volicer L, Nelson WA, Fox E, Derse AR. Ten myths about
decisionmaking capacity. J Am Med Dir Assoc. 2004;5(4):263-267.
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© Ann Jackson 102023
Back to Elizabeth
When is her capacity challenged?
By whom and why
Does she always have to agree with her sister or the
doctor?
Refusal alone should not be considered a sign of
incapacity?
In assessing capacity, providers should focus on
how patients arrive at a decision rather than the
decision itself.
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© Ann Jackson 102023
If Elizabeth has capacity,
can she sign her own
consent forms?
Let’s talk about Informed Consent
Definition:
Is the process by which the
treating health care provider discloses
appropriate information to a
competent patient so that the patient
may make a voluntary choice to
accept or refuse treatment.
https://www.nejm.org/doi/full/10.1056/NEJMcp074045
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© Ann Jackson 102023
Elements of Informed Consent
Obtain_Informed_Consent (ucla.edu), Informed Consent in Psychology Research (verywellmind.com)
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:
Informing the participants
about the purpose, duration,
and procedures of the
research or treatment
Providing adequate
information about the
benefits, risks, and
alternatives of the research
or treatment
Giving the participants the
right to decline or withdraw
from the research or
treatment
Conducting the process in a
manner and location that
ensures participant privacy
Responding to the
participant’s questions
Obtaining the participant’s
voluntary consent in writing
or verbally
Documenting the consent
process and keeping records
© Ann Jackson 102023
How much information is adequate to be provided to
consenting person, may or may not be the one who will
receive the care.
Reasonable Physician Standard
A standard of disclosure of information used in the wording of informed consent documents, based on customary
practice or what a reasonable practitioner in the medical community would disclose under the same/similar circumst
ances.
Cf.Arato v Avedon, Nathanson v. Kline, ‘Patient viewpoint’ standardMcGrawHill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
reasonable physician standard
In the giving of informed consent, the amount of information that a typical physician would provide to patients befor
e asking that they
decide to pursue or reject a treatment.
See also: standard
Medical Dictionary, © 2009 Farlex and Partners
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© Ann Jackson 102023
How much information should the patient receive?
Reasonable Patient Standard:
What is Subjective standard?
In the giving of informed consent, the amount
of information that a rational patient would wan
t before making a choice to pursue or reject a t
reatment or procedure.
WHAT would this particular patient need to
know and understand in order to make an
informed decision? This standard is the most
important challenging to incorporate into
practice, since it requires tailoring information
to each patient…THINK ABOUT TAILORING
for ELIZABETH
Reasonable patient standard | definition of reasonable patient standard by Medical dictionary
(thefreedictionary.com)
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© Ann Jackson 102023
Does
everything
need consent?
All health care interventions,
trimming toenails to
separation of Siamese twins
requires consent by the
patient, following a
discussion of the procedure
with a health care provider?
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© Ann Jackson 102023
There are always exceptions….
There are occasions, when it is acceptable
that the patient is not able to consent
If the patient does not have decision-making capacity,
such as a person with dementia, in which case a
proxy or surrogate decision –maker must be found.
A lack of decision-making capacity with adequate time
to find an appropriate proxy without harming the
patient, such as a life-threatening emergency where
the parent is not conscious
When the patient has waived consent.
When a competent patient designates a trusted lovedone to make treatment decisions for them. In some
cultures, family members make treatment decisions
on behalf of their loved-ones. Provided that the patient
consents to this arrangement and is assured that any
questions about their medical care will be answered,
the physician may seek consent from a family
member in lieu of the patient.
© E. Swirsky
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© Ann Jackson 102023
The case of Mary Schloendorff vs The Society of the New
York Hospital
Basic right to consent to medical care – Schoendorff v. Society of New York Hosp., 105 N.E. 92, 93
(N.Y. 1914)
Justice Benjamin Cardozo explained that reasoning in the court’s opinion:
“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. This is true except in cases of emergency where the patient is unconscious
and where it is necessary to operate before consent can be obtained.” (The court’s opinion can be found
online at: https://bit.ly/2lQmasY.)
Basic right to consent to medical care – Schoendorff v. Society of New York Hosp., 105 N.E. 92, 93 (N.Y. 1914) (lsu.edu)v
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© Ann Jackson 102023
Our Case
Case Example:
Elizabeth is a vibrant, out going 32-year-oldwho
self identifies as female who was diagnosed with
Downs syndrome soon after birth. Elizabeth lives
in an apartment with her older sister, she works
as a Pre-School teacher’s Aide and is actively
involved in social activities at her church and
with friends she met at school and during her
training.
Recently, Elizabeth told her sister, Margo that
she had a boy friend and wanted to have sex
with him. Margo, tried for weeks to keep the
couple apart and convince Elizabeth that it would
be too scary and might not be a good idea.
Elizabeth has continued to insist that she has the
right to make her own decisions. Margo agrees
and she and Elizabeth go to see Dr. Purez, their
family doctor.
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© Ann Jackson 102023
What’s the application
Establishing decision making capacity in those
you are trusted to care for may be a fluid
process. Decisional making capacity can come
from several sources, including a surrogate
decision maker.
No matter what we do in the medical care of a
person, consent must be obtained. The is only
achievable when the patient is introduced to the
idea, explained the task/service/treatment.
Demonstrates comprehension, able to ask
questions..then and only then should consent be
obtained.
I always ask myself the question,” Did I
set my patient up for success?”
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© Ann Jackson 102023