Danelle J. Hollenbeck
Introduction
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Informed consent is an ethical idea or concept which clients must understand and agree to prior to receiving an assessment, treatment, etc. This paper explores informed consent in treatment and confidentiality. It explores why it is important to acquire informed consent and maintain confidentiality when providing treatment. Due to restrictions in length of the paper, I will not focus on informed consent involving minors or the incapacitated.
Informed Consent in Treatment
Informed consent is an ethical and legal design to ensure clients are provided with knowledge and information about the treatment in which they are seeking, thus decide whether or not they want to participate in the treatment when the consent has been given to them and is worded in language that is easy to understand (Fishers, 2013, p.12). Standard in informed consent would be the nature of all information that is included in the procedures and steps that must be taken to protect the rights of children and adults with impairments, thus not able to provide consent (Fishers, 2013, p.12).
It is important that a practitioner receives informed consent for evaluations, assessments, and treatment, except when mandated by law (“APA Ethical Principles of Psychologists and Code of Conduct, “n.d.). Practitioners using the services of an interpreter must obtain informed consent from the client in order to use that interpreter, which ensures on behalf of the client that confidentiality is maintained. It is also imperative that practitioners inform (whilst obtaining informed consent) they inform clients as early as possible about fees involved, limits of confidentiality, and involvement of third parties (“APA Ethical Principles of Psychologists and Code of Conduct, “n.d.). Where I work we have a packet in which the first 4 sheets are consent to share information and include consent to share data to NTDMS, two charities we work in partnership with and would be providing services to clients, and social services. There is also a form they sign which states that information obtained in this assessment is confidential unless they are at risk to themselves or others, or have put a child at-risk. Informed consent also includes identifying a person’s professional identity, explaining the risks, and the client’s ability to discontinue treatment at any time.
According to Hudgins, et al (2013) “informed consent also includes the notice that is required by federal or state laws, professional ethical codes, or both, concerning the patient rights” (pg.11). this is very important to have so people entering into treatment know what their rights are. Effective ways to ensure the ethical standards are being met is to put informed consent in the patient handbook (Hudgins et al, 2013, p 8). The most powerful tool in compliance and ensuring ethical standards is to create a pathway into the informed consent process which exists right at the beginning. HIPAA patient material that is required and Part 2 can be included in the patient handbook, along with the “Mental Health Bill of Rights” that may be required by state statute Hudgins et al, 2013, pg. 8). Informed consent, as with any medical procedure, should be revisited and documented.
The practitioner has a duty to ensure the client is involved in ethical decisions about his or her care. The process of securing informed consent involves patient education by the practitioner (Rock & Hoebeke, 2014, pg. 4). Each patient is expected to be the guardian of their own body, as long as they are of sound mind. A patient of sound mind may choose not to go ahead with treatment, even if it is life-saving (Rock & Hoebeke, 2014, pg. 2). American law does not permit the practitioner to have personal judgment over the client (Rock & Hoebeke, 2014, pg. 2), nor permit the practitioner to assert personal judgment over the client. According to Rock & Hoebeke, “Respect for human dignity requires the recognition of specific patient rights, particularly, the right of self-determination. Self-determination, also known as autonomy, is the philosophical basis for informed consent in health care. Patients have the moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty” (2014). It is therefore imperative each person entering into treatment has the means allowed to accept or deny treatment by under which the means they understand it.
Another point to consider regarding informed consent is that although a practitioner may appoint a receptionist or nurse to obtain the written informed consent, it is legally and ethically the practitioner’s sole responsibility to ensure his or her client has been educated in regards to assessment and treatment. This cannot be delegated to a latter employee (Hock & Roebeke, 2014, pg. 3). Ethically and legally reliability getting informed consent lies within the practitioner providing treatment, which includes also the risks and benefits of the treatment.
Although delegation clearly is appointed at the pathway of treatment when doing an assessment, the practitioner does so at the sole discretion that they are doing so risking liability. Those who have been delegated this work should be properly trained as outlined in Standards 2.05 (“APA Ethical Principles of Psychologists and Code of Conduct, “n.d.) which states those who are delegated work have been properly trained (apa.org). Therefore the person witnessing the signature is knowledgeable and looks for clues to determine if the person is lucid and comprehends the informed consent. This can cause further ethical and legal situations if each person providing informed written consent is not coherent.
Finally, spontaneously signing the form by a patient should not be allowed. It is imperative that each patient reads and understands the forms they are signing. Signing without reading has been a habitual practice (Rock & Hoebeke, 2014, p. 4). The receptionist, nurse, or other point of contact before seeing the practitioner is the advocate of the patient, thus should assess the patient’s understanding of treatment. In practice, I have taken clients into a private room and read to them the informed consent forms to make sure they understand what they are signing.
I already employ all of these methods in my daily practice setting now when undertaking first contact, initial assessments, etc. I plan to use the Ethics Code and guidelines in the same manner in which I was trained. Because I am providing a service to people I must ensure they understand the service they are receiving. If they are not able to read or write, I will read it for them in a private setting, or if they require an interpreter I will employ Standard 2.05 (“APA Ethical Principles of Psychologists and Code of Conduct, “n.d.) and hire a trained interpreter. It is imperative I follow the Ethics Code in strict line with my work so that I am not jeopardizing my clients or also myself.
References
APA Ethical Principles of Psychologists and Code of Conduct. (n.d.). Retrieved from http://memforms.apa.org/apa/cli/interest/ethics1.cfm#10_01
Fisher,C.B. (2013).Decoding the ethics code: A practical guide for psychologists: includes the 2010 APA amendments to the ethics code(3rded.). Los Angeles [etc.: SAGE.
Hudgins, PhD,C., Rose, PhD,S., Fifield,P., & Arnault,S. (2013).Navigating the Legal and Ethical Foundations of Informed Consent and Confidentiality in Integrated Primary Care(Vol. 31). Retrieved from American Psychological Association website: http://eds.b.ebscohost.com.lib.kaplan.edu/eds/detail/
Rock,M., & Hoebeke,R. (2014). Informed consent: whose duty to inform?MedSurgNursing,23(3), 4. Retrieved from http://eds.b.ebscohost.com.lib.kaplan.edu
