Patient Autonomy and Informed Consent in Healthcare
Right to Health Information: Patient Autonomy Act
Patients have the right to be informed about their health and medical care. This includes:
- The right to know all available information about their condition and treatment options.
- The right to respect their desire not to be informed.
Providing Information
Information will generally be provided orally, with a record kept in the patient’s health care file. This information must include, at a minimum, the purpose and nature of any intervention, as well as the risks and consequences. The information provided will be truthful, understandable, and tailored to the patient’s individual needs.
All healthcare professionals involved in a patient’s care are responsible for providing information.
Ownership of Rights
- The patient is the primary owner of their health information rights. This includes those acting on behalf of the patient with their consent, whether express or implied.
- If a patient is unable to understand the information due to their capacity, a legal representative will be appointed.
- Related persons may be involved in the information-sharing process, taking into account the patient’s ability to understand.
Limits to the Right to Information
There are limited situations where the right to information may be restricted:
- Urgent Situations: When there is a vital therapeutic need that requires immediate action.
- Patient Refusal: When the patient explicitly expresses their desire not to be informed.
- Therapeutic Privilege: In rare cases, withholding information may be permissible if disclosure would be seriously detrimental to the patient’s health (e.g., risk of suicide after a cancer diagnosis).
- Fatal Forecast: Information may be delivered gradually or in a mitigated manner to avoid causing undue distress.
Informed Consent
Informed consent is a critical aspect of patient autonomy. It means that a patient makes a free and voluntary decision to undergo a medical intervention after receiving and understanding all relevant information and while in full possession of their faculties.
Form of Consent
Consent can be verbal in most cases. However, written consent is required for interventions that are invasive, pose significant risks (e.g., stress tests), or involve research.
Revocation of Consent
Patients have the right to revoke their consent at any time, either verbally or in writing.
Minimum Content of Informed Consent
To ensure valid informed consent, the following information must be provided:
- Relevant and important consequences of the intervention, including potential risks and benefits.
- Risks related to the patient’s personal circumstances.
- Risks that are probable under normal conditions, based on scientific knowledge and experience.
- Contraindications to the intervention.
Limits to Informed Consent
- A waiver of the right to be informed does not negate the need to obtain consent.
- Consent may be overridden in situations where there is a risk to public health.
- In emergencies where obtaining consent is not possible due to a serious and immediate risk, healthcare professionals may act in the best interests of the patient. Consultation with family members or a proxy decision-maker may be sought.
- Patients should be involved in decision-making to the fullest extent possible, respecting their dignity and autonomy.
- If a patient is incapable of making decisions, their legal representative will make decisions on their behalf. If no legal representative is available, a relative may be consulted.
- For patients under 12 years of age, the legal representative makes decisions. For those aged 12-16, the legal representative makes decisions, but the child’s opinion should be taken into account. Patients over 16 years old can make their own decisions, but parents should be informed and involved in cases of serious risk.
Secrecy and Confidentiality
Healthcare professionals have a legal and ethical duty to maintain the confidentiality of information obtained through their professional relationship with patients. This is protected by law, with breaches punishable under Section 199 of the Penal Code, which carries a penalty of imprisonment and fines.
Confidentiality is a reciprocal obligation, with patients expected to be truthful with their healthcare providers. This mutual trust forms the basis of the doctor-patient relationship.
Patients waive their right to privacy for the purpose of receiving medical care and treatment.
Exceptions to Confidentiality
There are limited exceptions to confidentiality when other rights or interests outweigh patient privacy:
- Patient’s Health or Safety: Confidentiality may be breached if there is a serious risk to the patient’s own health or safety, or the health and safety of others.
- Public Health: Healthcare professionals have a duty to notify authorities of certain infectious diseases to protect public health.
- Legal Proceedings: Patient information may be disclosed in response to a court order or subpoena.
Organ and Tissue Donation
Conditions and Requirements for Living Donors
- Donors must be adults or emancipated minors. In the case of minors, consent must be obtained from both the minor and their legal representative.
- Donors must be of sound mind and capable of making informed decisions. Individuals with mental impairments may not be eligible to donate.
- The organ or tissue being donated must be non-vital, meaning its removal will not result in the donor’s death.
- Donors must receive comprehensive information about the risks and benefits of donation and provide their free, conscious, and informed consent. This consent must be given in writing before a judge and witnessed by three doctors: the doctor performing the extraction, a doctor informing the donor of the risks, and the head of the transplant team.
- A report from the transplant hospital’s Ethics Committee is required.
- The donor’s physical and mental health must be assessed and certified by an independent medical professional.
- A minimum of 24 hours must pass between the signing of the consent form and the organ or tissue extraction. During this time, the donor can withdraw their consent at any time.
Conditions and Requirements for Organ and Tissue Donation from Deceased Individuals
- The deceased must not have expressed opposition to organ donation. This can be documented through a signed donor card, driver’s license designation, or other official means.
- For minors or individuals with disabilities, opposition to donation can be registered by their legal representative.
- Healthcare professionals must make reasonable efforts to determine the deceased’s wishes regarding donation by consulting with family members, reviewing medical records, or checking for a donor registry entry.
- Death must be certified by two independent physicians who are not part of the transplant team.
- Irreversible cessation of cardiopulmonary function or brain function must be confirmed.
- In cases of accidental death or death under suspicious circumstances, court authorization may be required before organ or tissue removal.
Clinical Use of Living Human Tissues
The use of living human tissues follows the same ethical principles as organ donation: free, voluntary, informed consent; anonymity; non-profitability; equity; and screening for contagious diseases. However, there are specific considerations for minors:
- Minors can donate surgical waste, hematopoietic stem cells, and bone marrow.
- Donation is generally limited to recipients with a genetic relationship to the donor.
- Consent must be obtained from both the minor and their parents or legal guardians.
- The child’s opinion and understanding of the donation process should be taken into account.