Malpractice forums

[Tigger]

Everyone has their own interpretation of informed consent. Hypotheticals like Alzheimer's or head injury is not germane to this discussion as none of these issues were part of the OP. IMO, pt gave informed consent. You can disagree.

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How do you possibly have enough information to make that determination? I think, therefore it is so?

You have provided no evidence to backup the assertion that signing the refusal somehow makes someone informed and competent. Signing something means nothing, as evidenced by the fact that there are many conditions in which a patient could have the cognitive ability to sign a form and have no idea what that means.

I have no idea whether or not this patient was competent to refuse or not. But having the patient simply say he does not want any evaluation is not somehow indicative of well, anything. If the patient walks away from you, fair enough. But some effort needs to put into a mental status examination before you divest yourself of the patient.

 

[MackTheKnife]

My husband suddenly collapsed unconscious. I called the paramedics and when they arrived, my husband had come around but it was obvious something was wrong with him. The paramedics asked him two questions; are you okay. He responded yes. And do you want to go to the hospital. He responded no. They had him sign a refusal of treatment and left.
This is part of the link from the OP. It's all from the spouse's perspective. Nothing about what the medics did or said from their perspective. So it's hard to know the pt's true competency or not. But going off of the limited info, I offered my opinion. The spouse said he RESPONDED yes. Not nod his head, wave his hand, etc. And he signed the form. And I hope Tigger didn't mean he would actually tell someone to sign a refusal form. As usual, we all have our opinions and we're all entitled to them.

 

[MackTheKnife]

BTW, as some of you will probably notice, and I'm sure, comment on, I changed my Education level to Paramedic. That is my education level, not certification. I am certified as an NREMT.

 

[Tigger]

My husband suddenly collapsed unconscious. I called the paramedics and when they arrived, my husband had come around but it was obvious something was wrong with him. The paramedics asked him two questions; are you okay. He responded yes. And do you want to go to the hospital. He responded no. They had him sign a refusal of treatment and left.
This is part of the link from the OP. It's all from the spouse's perspective. Nothing about what the medics did or said from their perspective. So it's hard to know the pt's true competency or not. But going off of the limited info, I offered my opinion. The spouse said he RESPONDED yes. Not nod his head, wave his hand, etc. And he signed the form. And I hope Tigger didn't mean he would actually tell someone to sign a refusal form. As usual, we all have our opinions and we're all entitled to them.

No I would not tell someone to, perhaps you have not noticed that I am arguing the opposite position. The only person I want signing a refusal form is someone who is competent to do so. As it turns out, asking someone if they're "ok" is not how you do that, and that is not subject to opinion.

Maybe that's what happened, maybe it isn't, I don't particularly care about the specifics of the example incident. In the bigger picture, we need to remember that it takes a bit of a time to establish competency on patients that are signing refusals, and asking them a few vague questions is not cutting it.

 

[ERDoc]

Everyone has their own interpretation of informed consent. Hypotheticals like Alzheimer's or head injury is not germane to this discussion as none of these issues were part of the OP. IMO, pt gave informed consent. You can disagree.

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I would have to disagree. Informed consent and informed refusal are pretty straightforward. One thing that someone who refuses has to demonstrate is that they have the capacity to make their own decisions. In order to have capacity they must understand what is wrong and what the consequences of their refusal means. If the crew only asked 2 questions, there is no way to say that the pt had the capacity. Alzheimer's or a head injury may not apply here but if the guy ended up in renal failure he very well could have been uremic or have metabolic encephalopathy.