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Posted on March 27th, 2013, by

An informed consent is a very important and still rather controversial issue of health care ethics and medical law. First of all, in order to understand the problem, it is significant to underline that informed consent is usually approached as an element of such a concept as the concept of the person. This concept is regarded as the procedural primacy in health care of the United States. What is more, the principle or the respect for persons is considered to be the cornerstone of medical ethics, fixed by law in many jurisdictions. Each person is respected, with taking to account the concern of welfare. Within the concept of the person, health care consent is viewed as a function of the importance accorded to autonomy. It means that each patient has a right to decide on his own whether to put his life under risk or not, to apply the proposed treatment or not, to take the prescribed medicine or not. Their life is their own life, but the choices they make are not only self-defining, but also self-creating, as Harris (2003) claims. “It is consent which makes laying your hands on someone else lawful ”“ hence the importance of obtaining valid consents to all medical procedures which involve interventions which compromise the bodily integrity of patients,” Harris (2003, 11) states. But it does not mean that the patient should simply say yes or no. His choice must be based on certain knowledge, in other words, the patient should be confident enough to understand all the outcomes of each option and decision he is free to take.

That is why the informed consent is said “to have been given based upon a clear appreciation and understanding of the facts, implications, and future consequences of an action,” according to the definition of Fisher (2006, 251). Adequate reasoning and all the necessary facts at the disposal of a patient are the obligatory conditions for taking the informed consent. Especially it is critical to care about the informed consent when the end of life decisions are at stake. By Harris (2003, 11), “end of life decisions are decisions to hasten death by active or passive means (doing or refraining) taken by or on behalf of the subject.”

In the case under consideration, not all the rules for informed consent were followed. First of all, Mrs. Sparza had bad English knowledge and thus she could not fully appreciate the information about her state and condition. Initially, when she signed the consent on the surgery of her one eye, this consent was really informed and reflecting her will. Her son was with her and could prevent her from incorrect decisions. But then, when the 70-year old woman was left alone, she became vulnerable and could not be competent enough to take a firm decision. “To give an informed consent you need to understand the nature of the course of action to which you are consenting, which, in medical contexts, will include its probable and possible consequences and side effects and the nature of any alternative measures which might be taken and the consequences of doing nothing,” Kleespies (2004, 1994) warns. What is more, she tried to refuse the surgery on both eyes, but doctor abused her lack of confidence and through the interpreter convinced her to agree. In this way, consent was expressed, but not internally given. The consent was expressed because of psychological confusion, and in this way the true will of the patient was violated.

Further on, in addition to improper obtaining of consent, Mrs. Sparza’s rights were again violated in the end-of-life decision making. Her will was expressed clearly: in case she goes into coma, to terminate the life support. She had the legal right to fix this will, because life is a value of person ,dsaf It is clearly stated that not to end life when it is required is the same cruelty as to deprive a person of proper treatment. A coma is not the same is full-value life, and if a person decides that cease to exist is better than to live in a vegetative state, it is the question of her autonomy, dignity and value. “If we respect the life plans and choices of others it will matter to us that those plans and choices are not frustrated,” Kleespies (2004, 1995) resumes. Well, the final consent was problematic, as Mrs. Sparza was unconscious after heart attack, but her will was legally passed to her children in role of her agents, and their will was also clear ”“ to terminate life support. Doctors were driven not by ethics, but by their own scientific and practical interest, because they are interested not in patients, but in diseases, that’s why they act correspondently. If the person is competent to choose life, he is competent to refuse it as well. At the same time, when the fatal injection was made, it was also violation of law, because in contrast to termination of life support, which is like a passive act, injection was an active act and can be referred to as a murder.

Fisher, J. A. (2006). Procedural Misconceptions and Informed Consent: Insights from Empirical Research on the Clinical Trials Industry. Kennedy Institute of Ethics Journal, 16(3), 251-268.
Harris, Jones (2003). Consent and end of life decisions. Journal of Medical Ethics, 29, 10-15.
Kleespies, Philip M. (2004). Life and Death Decisions: Psychological and Ethical Considerations in End-of-Life Care. The American Journal of Psychiatry, 161, 1934-1936.

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