Assignment Attachment Form

Anne Simpson Centre for International and Professional Education School of Nursing and Midwifery Curtin University of Technology GPO Box U1987 Perth, Western Australia 6845 Phone: +61 8 9266 3905 Fax: +61 8 9266 4084 Email: ipnursing.assign@curtin.edu.au

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Address: _Block 909, #12-102, Hougang St 91, _Singapore (530909) ___________________________ ______ Unit: ____ PPI 214__________

Student No: 14390203____ Date Submitted: 15.01.2010 Tutors Name: Pauline Costins

Index No.: _______________________ Assignment No. ________1__________

Assignment Title: (where applicable): Analysing the importance of gaining the clients consent prior to treatment Students Comments to Tutor, School of Nursing (if any) : _Nil___________________________

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Professional Practice Issues 214

Analytical Assessment
Marking Guide Students Name __________________________________________________ Possible mark Presentation: Cover and content page Attention to spelling, grammar, punctuation 12 font type with double spacing Reference list (a minimum of 8) uses APA format All in-text citations included using APA format Introduction:
Introduction that explains purpose & scope of the assignment The introduction includes a clear statement which expresses your point of view and gives the reader a clear idea of the main points that will be raised in the analytical essay

Mark attained

Analysis and Synthesis: Argument well structured Paragraphs include clear topic sentences The topic sentences relate to, and help demonstrate, the clear statement made in your introduction Analysis that reflects critical thinking rather than descriptive narrative Logical analytical thinking that follows the purpose of the assignment Is the evidence relevant, and accurately support your argument Organisational (synthesis) of reviewed articles follows a logical sequence Evidence of analysis and development of logical argument / synthesis of literature Relevance / understanding of issues The English expression clear and correct Critique to include: Evidence of critical review of literature The strengths, weaknesses or limitation of the literature you have reviewed Inconsistencies in the reviewed literature Gaps in the reviewed literature Conclusion: Does your conclusion sum up the argument? What are the implications for current nursing practice? TOT AL

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Title

Analysing the importance of gaining the clients consent prior to treatment

Word count: 1213

Contents
Introduction Background Autonomy Competent adults and consent Incompetent adults and consent Minors and consent Nursing practice and consent Conclusion References 6 6 6 7 8 8-9 9 10 11-12

Introduction
In the healthcare setting, before any treatment can be carried out, consent from clients is needed. Consent to treatment is central to the provision of healthcare delivery, but obtaining consent is a very complex issue. This paper aims to analyse the importance of gaining the clients consent prior to treatment among adults and minors. In general it is important and necessary to gain the consent prior to treatment. However, the clients consent can be withheld or their wishes can be overridden in special situations.

Background
Staunton and Chiarella (2008, p.116) defines consent as an agreement between two parties, and it requires a level of common understanding. Gaining the clients consent prior to treatment can prevent assault and battery (Staunton and Chiarella, 2008). Both Australian Nursing and Midwifery Council (ANMC) (2008) Code of Ethics value statement 5 and ANMC (2008, p.5) Code of Professional Conduct statement 7 highlight nurses value and support informed decision making of people requiring or receiving care. Generally gaining consent prior to treatment is routine and straightforward. However, issues of conflict arise in situations involving minors, people with mental illness, people with particular religious beliefs and emergency situations (Christine, 2005).

Autonomy
Consent is mainly based on one key ethical principle: autonomy (Aiken, 2004). The healthcare providers have a duty to respect the clients autonomy by gaining the consent prior to treatment. However, autonomy is not absolute.

Marks & Tindall (1993), Quallich (2005) and Lowden (2002) define autonomy is the right of the clients to determine what they want for themselves and the ability to control what happens to them. Beauchamp and Childress (1983) propose that peoples moral duty to seek informed, valid consent derives from the fact that the consenting party is an autonomous person. Singapore Nursing Board (SNB) (2006) Code of Ethics and Professional Conduct value statement 2 states that nurses should respect and promote clients autonomy. However, Davis, Fowler and Aroskar (2010) argued that some clients cannot make autonomous decisions because they are not autonomous people, such as very young children, persons subject to threat or other coercive influence, unconscious patients and so on.

Competent adults and consent

People over 18 year in Australia, barring any mental incapacity, can fully give and withhold consent to treatment, but there are some exceptions (Staunton and Chiarella, 2008). The clients have the right to refuse medical treatment including life saving treatment. Staunton and Chiarella (2008) questioned whether it is appropriate to keep a person alive just because it is possible to do so, and disregard the burden of the proposed treatment, which may outweighs the benefits. The healthcare providers must respect the consent of the clients. There may, however, be situations where competent adults consent can be withheld or their wish can be overridden. A competent adult may make irrational decisions, such as a lady who refuses tooth extraction because of fear of the dentist. Brazier (1991) commented that irrational decision should be override; however, Kennedy (1992) argued that an irrational decision

should be respected where it stems from long held beliefs and values. The healthcare providers should try to distinguish between different irrational decisions and act legally. When persons in emergencies or when the window for intervention is short and no legal representative is available to give consent within the time frame, their consent can be waived (Fish, 2004). In addition, there were cases where state courts override the clients decision of refusing blood transfusion, such as the Canadian case of Malette v Shulman et al. (as cited in Staunton and Chiarella, 2008, p.115). The state may require that the clients summit to treatment in order to get rid of a health threat to the community (Staunton and Chiarella, 2008).

Incompetent adults and consent

The capability to giving consent of incompetent adults varies. Aiken (2004) stated that if a client is unconscious, a legal guardian may have to consent for the treatment, and the courts may get involves in those complex cases where the client never discuss his/her wishes with the family and has not executed an Advance Directive. However, even if an incompetent client is conscious, such as psychiatric clients, there may still be argument of whether he or she is able to give consent rightly. Staunton and Chiarella (2008) and Mchale and Tingle (2007) distinguished that the law allows the voluntary psychiatric clients to give or withhold consent to treatment, but the Acts never allow the involuntary psychiatric clients to refuse the treatment in order to permit hospital authorities to carry out therapeutic procedures.

Minors and consent

Despite decades of guidelines, recommendations and legislation, minors consent to treatment remains complex and inconsistent (Lowden, 2002).

Minors in Australia refer to all young people under the age of 18 (NSW Law Reform Commission, 2004). The healthcare providers must take care to obtain consent appropriately prior to treatment. Generally a parent or guardian must consent to or refuse treatment for a minor (Hall, 1996). However, based on the law relating to minors Staunton and Chiarella (2008) argues that a minor is able to give valid consent to treatment if the child is capable of fully understanding the proposed treatment. For example, Marions case in Australia (as cited in Staunton and Chiarella, 2008, p.134), where the High Court ruled out the parents consent for a 14year-old girl with intellectual and physical handicap. It shows that parental consent can be waived for minors best interest. Gillick v West Norfolk and Wisbech Area Health Authority (1986) was seen as a landmark in support of minors autonomy, but it led to different interpretation. Montgomery (1988) stressed Gillicks competence indicated a transfer of legal power from parents to the minors, however Bainham (1988) argued that the power was not transferred to minors but to doctors. Meanwhile, Alderson (2000) analyzed some recent cases and pointed out that there is a fall in minors autonomy, where the courts overrode their refusal to treatment and they were forced to undergo treatment.

Nursing practice and consent

Guido (1997) and Davis, Fowler and Aroskar (2010) stated most nursing procedures rely on implied or verbal consent that may be readily inferred through the clients actions. Nurses and Midwives Board of Western Australia (NMBWA) (2006) Nurses and Midwives Act point 4 requires a nurse to inform the clients of their right to participate in decisions making affecting the clients

nursing care. AMNC (2008) National Competency Standards for the Registered Nurse statement 2.4 and SNB (2006) Code of Ethics and Professional Conduct value statement 7 highlight the role of the nurse as patient advocate. When the nurse is aware that the client does not understand the proposed treatment, she/he should contact the immediate supervisor and the responsible healthcare provider and request to speak to the patient to clarify the proposed treatment (Guido, 1997).

Conclusions
Consent to treatment is a complex issue, but it is one of respect for the clients autonomy and support for beneficence. The healthcare providers must be familiar with the relevant law and ethics, and be wise in obtaining the clients consent prior to treatment. The healthcare practitioners have to be mindful about what the client want indeed, or if the client cannot make his or her decision known due to a compromised physical and mental state, who is to speak in his/her best interest (Davis, Flowler & Aroskar, 2010).

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References:
Aiken, T.D. (2004). Legal, ethical, and political issues in nursing (2nd ed.). Philadelphia: F. A. Davis Company. Alderson, P. (2000). The rise and falll of childrens consent to surgery. Paediatric Nursing, 12(2), 6-8. Australian Nursing and Midwifery Council (ANMC). (2008). Code of Ethics for Nurses in Australia. Dickson: ANMC. Australian Nursing and Midwifery Council (ANMC). (2008). Code of Professional Conduct for Nurses in Australia. Dickson: ANMC. Australian Nursing and Midwifery Council (ANMC). (2008). National Competency Standards for the Registered Nurse. Dickson: ANMC. Bainham, A. (1988). Children, parents and the state. London: Oxford University Press. Beauchamp, T. L., & Childress, J. F. (1983). Principles of biomedical ethics (2nd ed.). New York: Oxford University Press. Brazier, M. (1991). Competence, consent and proxy consent. London: Routledge. Davis, A. J., Fowler, M. D., & Aroskar, M. A. (2010) Ethical dilemmas & nursing practice (5th ed.). Upper Saddle River: Pearson. Fish, S.S.(2004).Informed consent: Time for a national dialogue. Annals of Emergency Medicine, 43(4), 449-451. Gillick v West Norfolk and Wisbech Area Health Authority. (1986). Appeal Cases, 112-207. Guido, G. W. (1997). Legal issues in nursing (2nd ed.). Stamford: Appleton & Lange. Hall, J. K. (1996) Nursing ethics and law. Philadelphia: W. B. Saunders. Nurses and Midwives Board of Western Australia (NMBWA). (2006). Nurses and Midwives Act. East Perth: NMBWA. Kennedy, I. (1992). Consent to treatment: the capable person. In C. Dyer (Ed.). Doctors, patients and the law (pp.44-71). Oxford: Blackwell Scientific. Lowden, J. (2002). Childrens rights: a decade of dispute. Journal of Advanced Nursing. 37(1), 100-107.

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Marks, M., & Tindall, B. (1993). Ethics: a primer for nurses. London: Verena Tschudin. Mchale, J., & Tingle, J. (2007). Law & nursing (3rd ed.). Philadelphia: Elsevier. Montgomery, J. (1988). Children as property? Modern Law Review, 51, 323324. NSW Law Reform Commission (2004). Issues Paper 24: Minors consent to medical treatment. Sydney. Quallich, S. A. (2005). The practice of informed consent. Dermatology Nursing.17(1),49-51. Singapore Nursing Board (SNB). (2006). Code of ethics and professional conduct for nurses. Singapore: SNB. Staunton, P. J., & Chiarella, M. (2008). Nursing and the law (6th ed.). Sydney: Churchill Livingstone.

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