Informed consent for lumbar puncture
Article Abstract:
A major component in the doctor-patient relationship is the right of the patient to make informed choices regarding his medical care. The physician is required to tell the patient his diagnosis, the prognosis with and without treatment, and the treatment alternatives including their benefits and risks. There are four exceptions to the requirement of obtaining informed consent, including: medical emergencies; patients who are incompetent to make decisions; and cases in which the patient explicitly gives the physician the authority to make a decision. The fourth and most controversial exception is therapeutic privilege, the physician's right to withhold information he believes is harmful to the patient. An example of such a situation is withholding upsetting information from a patient who is in a coronary care unit and is not medically stable. Today the standard for disclosing information about a treatment is based upon whether a reasonable person would refuse the procedure if he had been informed of the risks. A signed consent form provides documentation that the communication process took place, however, a clear notation in the physician's records that the discussion occurred is often adequate. Parents or guardians are responsible for giving consent for treatment rendered to children; however, parents do not have an absolute right to refuse treatment for their children. The issue of informed consent for lumbar puncture (LP), a diagnostic procedure performed for suspected brain infection or meningitis, is discussed as it applies to a pediatric outpatient population. LP, in which spinal fluid is withdrawn from the spinal cord, is considered a safe procedure in this group of patients, and is also the only tool for diagnosing a life-threatening condition. Thus it has a high ratio of benefits to risks. For these reasons the physician could perform this procedure for diagnosing meningitis without parental consent; however, whenever possible informed consent should be obtained. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Diseases of Children
Subject: Health
ISSN: 0002-922X
Year: 1989
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Disclosure of a diagnosis to children and adolescents when parents object: a clinical ethics analysis
Article Abstract:
Pediatricians may face an ethical dilemma if parents do not want their sick child to know a diagnosis. Family dynamics, age of the child, nature of the illness and physicians' own values are all elements to be considered when parents request withholding a diagnosis. In one case, a native-Italian couple did not want their nine-year-old daughter told that she had cystic fibrosis. The physician initially went along with their decision, but became increasingly uncomfortable during the following nine years as the patient suffered three major complications. The parents continued to resist disclosure to their daughter. When the patient was 18 years old, the physician told her of her disease and the prognosis, still against the parents' wishes. This patient seemed to accept her parents' authority and the previous secrecy without question, probably due to cultural factors.
Publication Name: American Journal of Diseases of Children
Subject: Health
ISSN: 0002-922X
Year: 1993
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Confusion in the determination of death: distinguishing philosophy from physiology
Article Abstract:
Death in medical terms is defined as the irreversible cessation of respiratory, circulatory and brain functions. Society would also have to define death since it would also has philosophical implications. Medical technology has clouded the definition of death since machines have been invented that can support breathing and circulation. It is proposed that the whole brain standard be adapted to determine death. This standard relies on the ability of the human being to integrate various physiologic functions.
Publication Name: Perspectives in Biology and Medicine
Subject: Health
ISSN: 0031-5982
Year: 1992
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