Executive Summary

The report is prepared within short time. In my report I have included 8 parts. Introduction to Chapter I have included report origin, purpose, scope and methodology. In chapter 2 I have included in medicine, end-of-life care refers to medical  care not only of patients in the final hours or days of their lives, but more broadly, medical care of all those with a terminal illness or terminal condition that has become advanced, progressive and incurable. Goal of health-care is to promote health, to prevent disease and injury, to relief pain and suffering, and to avoid premature deaths.   Objective of medical end-of-life is to gather knowledge of social sciences basic to medicine and skills needed to provide care to culturally, ethnically and ecologically diverse populations irrespective of age or gender.  In chapter 3 I have included Consent, particularly informed consent, is the cornerstone of patients’ rights. In chapter 3 I have included Patient consent is the principle that you have to give express permission before any medical treatment can be carried out on you. Consent is needed, whatever the type of treatment, from a simple blood test to an organ donation. Decision should be the issue of patient consent rather than the subjective intention of doctor or nurse. Because it is not a breach against a patient’s rights if s/he consents to the termination of their life. In chapter 4 I have included that Law may be imposed if a doctor does not discuss the procedures and risks with a patient before the patient signs a consent form. In chapter 5 I have included strength, weakness, opportunity and threat. Patient can give their consent according to their choice. Threat is breach of confidentiality , In chapter 6 I have discussed limitation that Consent is not valid if the patient does not understand its meaning or if a patient has been misled. In chapter 7 I have explained that how to overcome this problem. Last of all I can say that decision should be the issue of patient consent rather than the subjective intention of doctor or nurse because it is not a breach against a patients right ifs\he consents to the termination of their life.

Table of Content

Chapter		Topic	Page
1		Introduction:	1-3
		1.1.        Report origin	1
		1.2.        Purpose	1
		1.3.        Scope	2
		1.4.        Methodology	2
		1.5.        Limitations	3
2		Introduction to medical end-of-life	4-5
		2.1.         What is medical end-of-life	4
		2.2.         Goal of medical end-of-life	5
		2.3.         Objective of medical end-of-life	5
3		Medical end-of-life: An overview of consent	5-16
		3.1:Consent	5
		3.2:Patient consent	6
		3.3: Decision should be the issue of patient consent rather than the subjective intention of doctor.	7-14
		3.4 Argument, Counter-argument and Response to the Counter-argument.	15-16
4		Law may be imposed on doctor	16
5		SWOT analysis	17-20
		5.1.Strength	17
		5.2.Weakness	18
		5.3.opportunity	19
		5.4.Threat	20
6		Limitation	21-22
7		Recommendation	22-23
8	Conclusion		23
9	Bibliography		23-24

INTRODUCTION

1.1 Report Origin

As a mandatory requirement of the Master of the Business Administration (MBA) program under School of Business of University of Ahsanullah University of Science and Technology, I required to complete the report. The report bears 10 marks. Report  is needed to gain idea, knowledge and experience practically about my theoretical ideas. This program provides the opportunity to learn about the real business world. For gathering this knowledge I have chosen this topic.

1.2.

Purposes

General Objectives

• To give on overview the primary focus in determining the legal permissibility of medical end-of-life. Decision should be the issue of patient consent rather than the subjective intention of doctor.

Specific Objectives

In line with the broad objective, the specific objectives of the study may be spelled out as follows:

• To show that decision should be the issue of patient consent rather than the subjective intention of the doctor or nurse.
• To provide an overall overview of medical end-of-life.
• To gain ideas about the legal permissibility of medical end-of-life).
• To identify the problems related to the legal permissibility of medical end-of-life.
• To recommend actions that may be necessary to solve the problems.

1.3. Scope

The report covers about medical end-of-life, patients consent, rights and responsibilities of patients consent, advantage of patients consent.

Within the stipulated time, I have covered some major topic. These are listed below and described in this report:

• The legal permissibility of medical end-of-life.
• About patients consent
• Subjective intention of doctors or nurses

1.4 Methodology

Both the primary as well as the secondary form of information is used to prepare the report. The details of these sources are highlighted below.

Primary Sources

Primary are collected by survey or study for specific purpose. We have collected primary data through the following ways:

• Face to Face conversation with the respective doctor and nurse.
• Practical work exposures on different desks.
• Practical experiences of the officials.
• Collection of relevant information from various departments

Secondary Sources

Sources of secondary data can be defined as:

Internal Sources

External Sources

q       Relevant books, Journals, Newspapers, Different Newsletters

q       Newspapers

q       Websites.

1.5. Limitation

Being required to complete the internship program and prepare the report timely we faced the following limitations.

¨     One month was a very short period to scrutinize all the activities.

¨     The major limitation was the sensitivity of the data. As it is a highly competitive market, release of material information to competitors have negative impact on business. As a result, in some cases management was reluctant to give some specific data.

¨     Extreme work pressure restricted the officials to give us much time even if they had cordial intentions to provide information.

¨     Some questions were avoided or not exactly answered   by the respondents may be because of lack of clear idea.

¨     Secondary sources of data in Bangladesh are very limited as sufficient books, publications and journals were not available.

¨     Being the report based on the experience of one month ,the findings may not be considered as representative one.

Despite all these limitations, I have given the best of my efforts and tried to make the report as informative and comprehensive as possible.

2. Introduction to medical end-of-life

2.1: MEDICAL END-OF-LIFE

End-of-life care

In medicine, end-of-life care refers to medical care not only of patients in the final hours or days of their lives, but more broadly, medical care of all those with a terminal illness or terminal condition that has become advanced, progressive and incurable. Regarding cancer care the United States national cancer institute writes:

When a patient’s health care team determines that the cancer can no longer be controlled, medical testing and cancer treatment often stop. But the patient’s care continues. The care focuses on making the patient comfortable. The patient receives medications and treatments to control pain and other symptoms, such as constipation, nausea, and shortness of breath. Some patients remain at home during this time, while others enter a hospital or other facility. Either way, services are available to help patients and their families with the medical, psychological, and spiritual issues surrounding dying. A hospice often provides such services. The time at the end of life is different for each person. Each individual has unique needs for information and support. The patient’s and family’s questions and concerns about the end of life should be discussed with the health care team as they arise…

Patients and their family members often want to know how long a person is expected to live. This is a hard question to answer. Factors such as where the cancer is located and whether the patient has other illnesses can affect what will happen. Although doctors may be able to make an estimate based on what they know about the patient, they might be hesitant to do so. Doctors may be concerned about over- or under-estimating the patient’s life span. They also might be fearful of instilling false hope or destroying a person’s hope. ^[1]

—————————————————————————————————Footnotes:

1.  en.wikipedia.org/wiki/End-of-life_care

2.2. GOAL OF MEDICAL END-OF-LIFE

Goal of health care is to promote health, to prevent disease and injury, to relief pain and suffering, and to avoid premature death.

2.3. Basic Objectives of MEDICAL END-OF-LIFE

Objectives

The ultimate objectives for medical end-of-life are given below:

• Knowledge of core concepts and principles of biological sciences from molecular to systems levels.
• Knowledge of social sciences basic to medicine and skills needed to provide care to culturally, ethnically and ecologically diverse populations irrespective of age or gender.
• Possession of a deep foundation of information about clinical diseases basic to medicine, including not only disease pathogenesis and treatment, but also health maintenance and disease prevention.
• Dedication to life-long learning: the ability to formulate scientific and clinical questions. Possession of the skills to identify resources to answer those questions as well as remaining current in their field of medicine.

3. Medical END-OF-LIFE: An overview OF CONSENT

3.1. CONSENT

·  A patient’s oral and written agreement to participate in a clinical trial. Consent is based on full disclosure about the treatment, its potential risks and benefits, alternative treatments, and any other information the patient needs to make the decision.Consent is based on the inviolability of one’s person. It means that doctors do not have the right to touch or treat a patient without that patient’s approval because the patient is the one who must live with the consequences and deal with any dis-comfort caused by treatment. A doctor can be held liable for committing a battery if the doctor touches the patient without first obtaining the patient’s consent.Consent must be voluntary, competent, and informed. Voluntary means that, when the patient gives consent, he or she is free from extreme duress and isnot intoxicated or under the influence of medication and that the doctor has not coerced the patient into giving consent.

Consent is not valid if the patient does not understand its meaning or if a patient has been misled.

—————————————————————————————————

Footnotes:

2. Paragraph: Definition of consent

www.ecri.org/patient/|references/page/|clinical_Trial_Patient_References_Guide_Glossary_.aspx

3.2: PATIENT CONSENT

Patient consent is the principle that you have to give express permission before any medical treatment can be carried out on you. Consent is needed, whatever the type of treatment, from a simple blood test to an organ donation

What constitutes consent?

Consent can only be said to have been given if it is both voluntary and informed. These terms are described below.

• Voluntary: the decision to consent (or not consent) to treatment must be your own, and not the result of coercion by medical staff, friends or family.
• Informed: you must be given full information about what the treatment involves, the benefits and risks, whether there are any other reasonable alternative treatments, and what will happen if treatment does not go ahead.

The only circumstance where treatment can go ahead without your consent is if you do not have the mental capacity to make a decision regarding your treatment, and the healthcare professionals believe that treatment is in your best interests.

—————————————————————————————————Footnotes:

3. Paragraph: Laws of patient consent

www.cks.nhs.uk/patient_information…/consent_to_treatment – Cached – Similar

3.3: DECISION SHOULD BE THE ISSUE OF PATIENT CONSENT RATHER THAN THE SUBJECTIVE INTENTION OF DOCTOR

Decision should be the issue of patient consent rather than the subjective intention of doctor or nurse.

• The primary focus in medical end-of-life decisions should be on patient consent, rather than doctor intention because it is not a breach against a patient’s rights if s/he consents to the termination of their life
• Decision should be the issue of patient content rather than the subjective intention of doctor or nurse .Before starting any operation of any patient , doctor takes permission from patients .Because doctors or nurses do not want to take risk if any patient die.
• The primary focus in medical end-of-life decisions should be on patient consent, rather than doctor intention. Because a doctor who treats without patient consent will be liable under the tort and criminal laws.

• Doctors do not have the right to touch or treat a patient without that patient’s approval because the patient is the one who must live with the consequences and deal with any discomfort caused by treatment. A doctor can be held liable for committing a battery if the doctor touches the patient without first obtaining the patient’s consent.

• If patient is due to undergo a major medical intervention, such as an operation, patient consent should be sought well in advance, so that patient has plenty of time to study any information relating to the procedure. Patient should also have the opportunity to ask as many questions as patients want.
• There may be some circumstances when, during an operation, it becomes obvious that you would benefit from an additional procedure that was not in the scope of your original consent. For example, you may be undergoing abdominal surgery and the surgeon notices that your appendix is infected, dangerously close to bursting, and needs to be removed.
• If it is felt that it would be too dangerous to delay the additional procedure in order to wake you up to obtain your consent, the additional procedure can go ahead providing that it is in your best interest.
• However, additional procedures cannot go ahead just because it would be convenient for the medical staff. There has to be a clear medical reason why it would be unsafe to wait and obtain your further consent.
• If you require emergency treatment in order to save your life, and you are unable to give consent as a result of being physically or mentally incapacitated, treatment will be carried out.

———————————————————————————————-Footnotes:

4.  My own view

How is consent given?

Consent should be obtained from the healthcare professional who is directly responsible for your current treatment. This could be a nurse who is arranging a blood test, a GP who is prescribing new medication for you, or a surgeon who is planning your operation.

Consent can be given:

• verbally,
• non-verbally – for example, you may raise your hand to indicate that you are happy for a nurse to take a blood sample, or
• in writing – by signing a consent form.

A signed consent form by itself does not constitute consent; it simply serves as evidence of consent. If your consent is not voluntarily, informed, or you do not have the sufficient mental capacity to give consent, the consent form will not be valid.

Capacity

Under the terms of the 2005 Mental Capacity Act, all adults are presumed to have sufficient capacity to decide on their own medical treatment unless there is significant evidence to suggest otherwise.

The evidence has to show that:

• a person’s mind, or brain, is impaired or disturbed, and
• The impairment or disturbance means that the person is unable to make a decision at the current time.

Examples of impairments or disturbances in the mind or brain include:

• mental health conditions, such as schizophrenia or bi-polar disorder (manic depression),
• dementia,
• serious learning disabilities,
• long-term effects of brain damage,
• physical or mental conditions that cause confusion, drowsiness, or a loss of consciousness,
• delirium, and
• intoxication caused by drug or alcohol abuse.

Someone is thought to be unable to make a decision if they cannot:

• understand information about the decision,
• remember that information,
• use that information as part of their decision-making process, or
• communicate their decision by talking, using sign language, or by any other means.

• If someone makes a decision about treatment that most people would consider to be irrational, it does not constitute a lack of capacity if the person making the decision understands the reality of their situation.
• For example, a person who refuses to have a blood transfusion because it is against their religious beliefs would not be thought to lack capacity because they understand the reality of their situation, and the consequences of their actions.
• However, somebody with anorexia, who is severely malnourished, yet rejects treatment because they refuse to accept that there is anything wrong with them, would be considered to be incapable because they do not understand the reality of their situation.

In some cases, people can be considered capable to decide about some aspects of their treatment, but not about others. For example, a person with severe learning difficulties may be capable of deciding about their day-to-day treatment, but be incapable of understanding the complexities of their long-term treatment.

Also, some people with certain health conditions may have periods when they are capable, and periods when they are incapable. In such circumstances, a person can make a ‘living will’ or ‘advanced directive’, stating how they would like to be treated, or not treated, in case of future incapacity.

If a person specifically states in their ‘advanced directive’ that they do not want to undergo a particular treatment, this is legally binding unless they are being held under the Mental Health Act.

Refusing treatment

If you have sufficient capacity and make a voluntary and informed decision to refuse a particular treatment, your decision must be respected. This is still the case if your decision would result in your death, or the death of your unborn child.

You are still entitled to any other appropriate medical treatment and care that is felt would be in your best interest.

However, if you request a course of a treatment that health care professionals believe would not be in your best interest, they have no obligation to provide it.

Children and teenagers

Teenagers who are 16 and 17 years of age are entitled to consent to their own treatment, and this consent cannot be overruled by their parents.

Children who are under 16 years of age can also consent to their own treatment if it thought that they have sufficient intelligence, competence, and understanding to fully appreciate what is involved in their treatment.

No one except the courts can override the consent of a child who is under 16 years of age. However, a person who has parental responsibility for a child, or teenager aged 16 or 17, can override that consent if the child refuses treatment.

Parental responsibility

The mother of a child, and the child’s father (if he is married to the mother) automatically have parental responsibility. If the parents are not married, the father will have parental responsibility if he acted with the mother to have his name recorded in the registration of the child’s birth, and the child’s birth was registered after 1st December 2003.

An unmarried father can also obtain parental responsibility by later marrying the mother, by making a parental responsibility agreement with her, or by getting a court order.

Parental responsibility can also be granted to other people by the courts, such as a legally appointed guardian. As with other adults, people with parental responsibility can only provide, or refuse, consent if they are thought to be capable.

If a parent refuses to give consent to particular treatment, this decision can be overruled by the courts if treatment is thought to be in the best interests of the child.

In an emergency, where treatment is vital, and waiting to obtain parental consent would place the child at risk, treatment can proceed without consent.

Prisons

The legal rights of prisoners are unaffected when it comes to the issue of consent. No capable prisoner can be treated without consent even if that means their life will be at risk. This includes a prisoner who is refusing to eat food.

Exceptions

There are a number of exceptions whereby a capable person can be treated without first obtaining their consent. These exceptions are listed below.

• Under the terms of the Public Health (Control of Disease) Act, a magistrate can order that a person be detained in hospital if they have an infectious disease that presents a risk to public health. Diseases that are covered by the Act include rabies, cholera, and anthrax.
• Under the terms of the National Assistance Act, a person who is severely ill, or infirm, and living in unsanitary conditions, can be taken to a place of care without their consent.
• Under the terms of the Mental Health Act, people with certain mental health conditions, such as schizophrenia, bi-polar disorder, or dementia, can be compulsorily detained at a hospital, or psychiatric clinic, without their consent.

Complaints

If you believe that you have received treatment for which you did not provide consent, you can make an official complaint. You can either use the NHS complaints procedure, or you can contact the General Medical Council (GMC).

The GMC only investigates complaints that relate to doctors, rather than other health care professionals, such as nurses.

If your complaint is upheld, the GMC can issue a formal warning to the doctor involved. In the most serious of cases, the doctor’s licence to practice medicine can be withdrawn.

The GMC cannot provide you with compensation for any liability, or injury, relating to your complaint.

The NHS complaints procedure can be used to complain about any NHS staff member who is involved in your treatment. You must make sure that you make your complaint within six months of the event you are complaining about. In some cases, compensation may be available.

Problems With holding information

Healthcare professionals should not withhold information out of concern that it may upset or unnerve a patient. Even if you specifically request not to be told about the extent or likely prognosis of your condition, the healthcare professional has both a moral and legal responsibility to provide you with at least a basic overview of your condition, its likely outcomes, and your treatment options.

Similarly, any request that you may make to a healthcare professional to withhold information about a relative, or a loved one’s condition, due to fear that it may upset them, will be met with a refusal.

Mental health conditions

People who have conditions that are covered by the Mental Health Act (1983), such as schizophrenia or bi-polar disorder, may not be competent to give consent. However, this should not be taken for granted and needs to be assessed at the time that consent is required.

The patient’s preferences should be investigated, and their agreement to treatment should be sought, whenever they are able to make a rational decision. These wishes should be respected if, later on, the patient is not able to give proper consent.

If the patient lacks capacity and has not previously expressed their wishes, their mental health condition may be treated without consent, as may any related conditions – for example, those resulting from self-harm. Unrelated physical conditions cannot be treated without consent.

An advanced directive prohibiting certain kinds of treatment can be overruled if you are being held under the Mental Health Act, even if you wrote the advanced directive when you were capable. For example, you may have stipulated that you do not wish to be treated with antipsychotics. However, if your medical staff feel that the use of antipsychotics is required to prevent possible danger to yourself, or to others, their use will be allowed.

Self harm and attempted suicide

In cases of self-harm, or attempted suicide, where the person refuses treatment, and was competent when they made the decision to harm themselves, it may be necessary to see if they can be treated without consent under the Mental Health Act. This can happen if a person has a serious mental disorder that requires hospital treatment.The person’s nearest relative, or an approved social worker, must make an application for the person to be forcibly kept in hospital and treated, and two different doctors must assess the person’s condition.

If a person is kept in hospital under the Mental Health Act, it does not automatically mean that they are no longer able to agree to treatment. However, they will need to be reassessed to find out if they are capable of making an informed decision.

If a person has tried to harm themself, but does not have a mental disorder that is covered by the Mental Health Act, unwanted treatment cannot be forced upon them, although efforts to offer treatment must be made.

Intervening when the patient lacks capacity

If an adult lacks capacity, any physical interventions must be in the ‘best interest’ of the patient. Firstly, it must be determined whether the person has previously expressed any opinions regarding certain procedures, perhaps on the grounds of religious or moral beliefs. This wish must be respected. It is only when the patient may die if an intervention is not made, that this can be carried out without consent.

However, if the patient had already expressed a clear opinion on this matter, the doctor cannot override this, whatever the consequences, unless the person is being held under the Mental Health Act.

If it is safe to wait until the patient can provide their permission, this must be done. In such circumstances, doctors are advised to refer to a senior colleague for advice. Any doubts can be referred to the High Court for a decision.

Court decisions

There are some circumstances where a decision should always be referred to a court, if the person cannot, or will not, give their permission. These situations include:

• sterilisation for contraceptive purposes,
• donation of regenerative tissue, such as bone marrow,
• withdrawal of nutrition and hydration from a patient in a persistent vegetative state, and
• where there is serious concern about the patient’s capacity, or best interests.

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Footnotes:

5. Paragraph: Patient information leaflet (consent to treatment)

www.cks.nhs.UK/patient information/ consent to treatment

3.4: Look at the following table which shows an argument , counter-Argument, and one possible response to the counter-Argument  :

ARGUMENT

The primary focus in medical end-of-life decisions should be on patient consent, rather than doctor intention, because it is not a breach against a patient’s rights is/he consents to the termination of their life.

Counter –argument

Terminally ill patients are likely to be depressed, and therefore unable to consent to their hastened death in a   balanced or acceptable way.

Response to the Counter-argument

Depression can be managed. The relevance of depression  must be made on a case-by-case basis. Depression does not warrant a general rule prohibiting patients from consenting to a hastened death.

Look at another counter argument and the writer’s response to it where, once again, merit in the counter- Argument  is conceded :

Argument

The primary focus in medical end-of-life decisions should be on patient consent, rather than doctor intention, because it is not a breach against a patient’s rights if s/he consents to the termination of their life.

Counter-argument

Vulnerable people might be persuaded by relatives or hospitals to consent to early death because it will save costs, and it is the law’s duty to protect vulnerable people

Response to counter-argument

The law could introduce rigorous procedures for establishing consent, and introduce heavy penalties for those who do try to influence decisions.

Argument

The primary focus in medical end-of-life decisions should be on patient consent, rather than doctor intention, because it is not a breach against a patient’s rights if s/he consents to the termination of their life.

Counter-argument

Allowing voluntary euthanasia will result in less respect for life (for example in a greater tolerance of non-voluntary euthanasia), and this is to be avoided.

Response to counter-argument

Evidence from the Netherlands shows that liberal euthanasia laws do not lead toan increase in non-voluntary euthanasia; if anything they lead to a decrease. Respecting individual choice might lead to greater respect for life, not less.

——————————————————————————————————————————————————————————————————————————————–Footnotes:

6. Argument and counter argument of patient consent

www.monash.edu.av/iis/llonline/writing/law

4: WHEN LAW IS IMPOSED ON DOCTORS

¨      If a doctor does not discuss the procedures and risks with a patient before the patient signs a consent form.

¨      If a doctor failed to inform you of a material fact relating to your treatment. A material fact is a fact that a reasonably prudent patient in the same position as you would consider significant to deciding whether or not to consent to the proposed treatment.

¨       If you show that you consented to the treatment without being aware of or fully informed of the material fact. For example, did your doctor fail to inform you of the risk of experiencing extreme pain after the treatment.

¨      If doctors do not take permission from patients before treatment and if patient die then the patient will be liable.———————————————————————————————————

Footnotes

7 Young P. W,   The Law of Consent, (1st ed, The Law Book Company Limited, Sydney, 1986) p.131

5.SWOT ANALYSIS

SWOT Analysis is an important tool for evaluating the company’s Strengths, Weaknesses, Opportunities and Threats. It helps the organization to identify how to evaluate its performance and understand the macro environment, which in turn would help the organization to navigate in the turbulent ocean of competition. —————————————————————————————————————————————————————————————————-

-Footnotes

8.Swot analysis

www.britannica.com/—/the home

10.1. Strengths

1. Point of contact Patients visit the physician’ s website and create a personal account to view online education seminars. Patients can also receive log-in information when they call the physician’ s office to inquire about a procedure or service.

2. Pre-visit The physician’ s office automatically receives an email when an account has been created through the website. This enables office staff to call or email the patient to start building a relationship and answer any questions the patient may have.

3. Confirmation of course completion Once a patient has completed the seminar, the physician will receive an email notification with quiz results and general usage information. This can be filed in the patient’ s chart in preparation for the office visit.

4. Pre- and post-operative consultation During the consultation, the patient’ s online education record is reviewed and any final questions are answered. This can be an additional verification to the informed consent process.

5. Post-op care Patients can review post-op care instructions online and share them with their family and caregivers.

6. Follow-up Online follow-up courses can provide relevant information related to patient procedures. This will improve patient satisfaction and strengthen marketing efforts.

WEAKNESS

¨      Consent is not valid if the patient does not understand its meaning or if a patient has been misled.

¨       In most other cases, however, it is clear that the patient himself is not competent to make his/her own decisions- patients can be under an unusual amount of stress during illness and can experience anxiety, fear, and depression. In other case, the patient might not be well educated/aware or confident enough to make a choice in his/her best interest. The concept of informed consent, however, still holds good

¨      Terminally ill patients are likely to be depressed, and therefore unable to consent to their hastened death in a balanced or acceptable way.

¨      Too much money in the system leads to physician excesses and unreasonable expectations of patients, often avoiding or postponing difficult decisions.

¨      The rising costs of cancer therapy are not sustainable, no matter how much they squeeze the docs.

¨      Technological advances have increased the cost of care, further straining the system.

¨      Failure to come to grips with rationing health care (e.g., millions for separating conjoined twins while American children go without routine health care).

¨      Pharma [and the public] conspire to use the flashy new drug with the greatest financial impact, not the greatest medical impact.

¨      I hate having to monitor the percent of Medicare patients in my practice due to poor reimbursement.

¨      Limited use of computerized order entry; oncologists give drugs with the narrowest therapeutic/toxic window and should be in the vanguard of office-based.

OPPORTUNITY

¨      Patients can give their consent according to their choice.

¨      Meaningful  choice.

¨      The concept of meaningful choice is important because its terms protect a patient’s expectation of privacy, according to Deven McGraw, the chair of the tiger team and director of the Health Privacy Project at the Center for Democracy and Technology.

¨      There are enormous opportunities because the system is so broken, dysfunctional, and non-existent-e.g., a single electronic medical record that can communicate across all systems and platforms; this is one of many opportunities for the federal government.

¨      Use current technology to see how well we are doing and improve care (e.g., the Quality Oncology Practice Initiative). * Huge opportunity for applying newer treatments (if we can afford to do it and stay in business), to offer them to all who need them and not squander resources carelessly.

¨      Better systems of collaboration between community and academic oncologists; many academic centers are creating more community oncologists but neglect development of focused experts [to whom one can refer rare or difficult problems].

¨      A huge opportunity at improving the quality of care not only in medical oncology, but also surgical and radiation oncology, diagnostic imaging and pathology; each has a major influence on the quality of care.

¨      Improved methods of doctor-patient communication, decision support, and awareness.

¨      Better models for management of patients with advanced cancer.

¨      Move more toward skeptical, evidence-based oncology to take the high road in the quality, science, and delivery of care,

¨      Better collaboration of national organizations with each other.————————————————————————————————————————————————————————————————–

Footnotes

9.Patient consent (in the news)

Govhealthit. com/new sitem. aspx? nid=744401

THREAT

¨      Breach of patient confidentiality is a threat.

Breach of patient confidentiality refers to incident where patient’s confidential information, learned by the doctor within the physician-patient relationship, is divulged to a third party without the former’s consent or court order.

Breaching can be oral, written, or done via telephone or fax, or electronically by using email or health information network. Importantly, the medium of disclosure is not important but special security requirements may apply to the electronic transfer of information.

¨      The piece-meal approach to fixing systemic problems, e.g., MMA, results in serious unintended (but foreseeable) consequences for patients.

¨      Growing expectations for unreasonably positive outcomes due to hyper-optimism and marketing.

¨      Potential for an adversarial breakdown of relations between hospitals and doctors; with money exiting the system, physician purchases of CT and PET scanners, and radiation therapy equipment directly competes with hospitals.

¨      Ignoring rapidly rising drug costs for all, the inevitable increase in those who cannot afford care and the widening gap between those who can and cannot afford to pay for therapy.

¨      Continuously falling compensation may cause early retirements or curtailment of practices, leaving fewer, overly burdened practices; the public and Congress don’t unde rstand that at this rate we will end up with too few resources and providers to give care they expect.

6. LIMITATION

In some cases the patient himself is not able to give consent.

¨      Consent is not valid if the patient does not understand its meaning or if a patient has been misled.

¨      This may include the two obvious groups- paediatric patients and the mentally challenged patients, in which case consent is usually taken from the parents/guardians. The third group is that of the accident and emergency patients, where the onus usually lies with the doctor to act in the best interest of the patient and take what is known as the ‘implied consent’ of the patient.

¨      In most other cases, however, it is clear that the patient himself is not competent to make his/her own decisions- patients can be under an unusual amount of stress during illness and can experience anxiety, fear, and depression. In other case, the patient might not be well educated/aware or confident enough to make a choice in his/her best interest. The concept of informed consent, however, still holds good.

¨      As discussed earlier, there are three reasons for taking consent- to inform the patient because it is good practice, to involve the patient since he might already be aware and is interested in making a sound choice, and in the third case, to practice consent as a risk management technique. In this case the third reason stands its stead.

¨      Even if the patient himself cannot make an informed choice, and neither can a surrogate decision maker; it is still important to convey the choices, the risks and benefits involved, and make sure that the patient atleast understands them and signs that understanding in a written format-called the consent form. Within the ever-changing sphere of hospital management practices, the issue of patient consent is also an important one and if adhered to, can provide benefits for the hospital.

¨      Terminally ill patients are likely to be depressed, and therefore unable to consent to their hastened death in a balanced or acceptable way.

¨      Vulnerable people might be persuaded by relatives or hospitals to consent to early death because it will save costs, and it is the law’s duty to protect vulnerable people

¨      Allowing voluntary euthanasia will result in less respect for life (for example in a greater tolerance of non-voluntary euthanasia), and this is to be avoided.

———————————————————————————————Footnotes

10. Argument and counter argument

www.monash.edu.av/iis/iionline/writing/law legal/—/2.3.3xmn

7. RECOMMENDATION

¨      Consent must be valid .If the patient does not understand its meaning or if a patient has been misled, then consent will be invalid.

¨      Patients must give their consent for their personal data to be recorded on the NJR.

¨      Consent must be voluntary, competent, and informed. Voluntary means that, when the patient gives consent, he or she is free from extreme duress and is not intoxicated or under the influence of medication and that the doctor has not coerced the patient into giving consent.

¨      The law presumes that an adult is competent, but competency may be an issue in numerous instances. Competence is