Patient Rights the Major Objective of Informed

Patient Rights

The major objective of informed consent is to give the patient an opportunity play a role in his health care decision. The law requires physicians to get an informed consent of their patients before any medical procedure. The patient has a right to be informed and to be made aware of the nature of the procedure, available alternatives to the medical operation, the risks, benefits and uncertainties related to the operation as well as the patient's acceptance of the operation.

For a patient's consent to be valid, he must be considered competent to voluntarily make the decision (Edwards, 1998). However, there are conditions that may render a patient incompetent to make treatment decisions. In the case of Mr. Jones who has been diagnosed with Alzheimer's disease, the law provides for an option. According to section 5 article a of the National Conference of Commissioners;

"A surrogate may make a health-care decision for a patient who is an adult or emancipated minor if the patient has been determined by the primary physician to lack capacity and no agent or guardian has been appointed or the agent or guardian is not reasonably available" (National Conference of Commissioners, 1993).

In Mr. Jones case, that person is his adult daughter as stipulated in section 5 article b, 2. With this understanding, the process is legally seen as an invitation to Mr. Jones through his daughter to participate in his health care decision. The medical practitioners are also obligated to share their reasoning process with her as the surrogate decision maker. Medical ethics require the judgment of the involved parties to reflect a societal judgment about the perfect balance between respecting the patient's wishes and protecting him from the consequences of a bad decision (Appelbaum, 2007).

Determining capacity

It is recommended that physicians assess a patient's decision-making capacity more carefully when he refuses recommended treatment and not ready or willing or when the refusal is based on irrational reasoning or even without carefully considering the benefits of the operation (Tunzi, 2001 ). It is clear that Mr. Jones is competent, but the question is whether he has the capacity to understand the ranifications of his resusal, physicians are legally required to make decisions regarding the patient's capacity not competency ( p. 300). In the presented senerio, the social worker commented that Mr. Jones's daughter might have been afraid of an elder-neglect investigation if her father died. In order to clarify such claims, it is advisable for Mr. Jones primary care to perform the capacity assessment. This is because the primary physician is aware of his medical situation and the question at hand. The primary physician may also be in the best position to understand the family's values and religious views. In addition, this provides the benefit of medical history and an establishment of an ongoing medical relationship with the patient (Grisso & Appelbaum, 1998).

Capacity Assessment

Legally, physicians do not make judgments about capacity; they are supposed to be made by courts in accordance with state laws where the patient lives. It is recommended that local authorities be consulted for specific and detailed legal clarifications and procedures (Appelbaum, Lidz, & Meisel, 1987). These cases seldom make it to courts and in case they do, the court's decision always agrees with physician's assessment capacity.

The assessment of a patient can follow a directed clinical method or a formal structured assessment. Directed clinical method involves asking Mr. Jones a set of questions to determine

His ability to the proposed procedure

His ability to appreciate how that information applies to his situation

His ability to reason with that information in a manner that is supported by the facts and his own values

His ability to communicate and express a choice clearly:

In addition to this ability assessment, a mental status examination must be conducted to determine the influence of psychopathologic factors on the patients thinking.

Other than a directed clinical interview, physicians can use a formal structured assessment tool in evaluation of Mr. Jones capacity and one such tool is the Aid to Capacity Evaluation (ACE) (Sullivan & Youngner, 1994). This tool supposedly results in more objective assessment than the interview and uses standardized questions and scoring mechanism. Aid to capacity evaluation generally seeks to investigate the patient's ability to Understand medical issue

Understand proposed operation

Understand alternative to proposed procedure

Understand option of refusing proposed procedure

Understand reasonably foreseeable outcome of accepting proposed procedure

Understand reasonable foreseeable outcome of refusing proposed procedure

In addition, ACE examines whether the patient's decision is affected by depression or delusion.

The law allows for the appointment of a surrogate decision maker for a patient who is deemed incapacitated by the physicians after careful evaluation. Therefore, surrogate as explained in the preceding paragraphs, is authorized to make medical decisions on behalf of the patient. Mr. Jones daughter in the presented scenario is the surrogate if after evaluation, he is found to lack capacity to make the right medical decision.