Health literacy

While levels of health literacy differ among countries, on average nearly every other citizen possesses a low level of health literacy. The result is a challenge not only for health professionals but also for systems at large.

Recommendations from European Health Literacy Survey is that health care professionals should adjust their expectations in assuming the levels of health literacy and literacy of their patients.  Health education and its assessment needs to be integrated into school curricula from the earliest years to school leaving age.

Health literacy should be included in the development of all health promotion initiatives at all levels from primary care to national health promotions.

Informed consent

Components of Informed Consent

There are 4 components of informed consent:

  • You must have the capacity (or ability) to make the decision.
  • The medical provider must disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the likelihood (or probability) that the benefits and risks will occur.
  • You must comprehend the relevant information.
  • You must voluntarily grant consent, without coercion or duress.

Decision-Making Capacity

Decision-making capacity is often referred to by the legal termcompetency. It is one of the most important components of informed consent. Decision-making capacity is not black and white. You may have the capacity to make some decisions, but not others.

The components of decision-making capacity are as follows:

  • The ability to understand the options
  • The ability to understand the consequences of choosing each of the options
  • The ability to evaluate the personal cost and benefit of each of the consequences and relate them to your own set of values and priorities

If you are not able to do all of the components, family members, court-appointed guardians, or others (as determined by state law) may act as “surrogate decision-makers” and make decisions for you.

To have decision-making capacity does not mean that you, as the patient, will always make “good” decisions, or decisions that your doctor agrees with. Likewise, making a “bad” decision does not mean that you, as patient, are “incompetent” or do not have decision-making capacity.

Decision-making capacity, or competency, simply means that you can understand and explain the options, their implications, and give a rational reason why you would decide on a particular option instead of the others.

Disclosure

In order for you to give your informed consent for treatment or tests, the doctor or health care provider must give (or disclose) to you enough information so that you can make an informed decision. It is not necessary or expected that you would receive every detail of the test, treatment, or procedure. You need only the information that would be expected by a reasonable person to make an intelligent decision. This information should include the risks and likelihood (or probability) of each of the risks, and the benefits, and likelihood (or probability) of benefit. Any questions you have should be fully explained, in language and terminology that you can understand.

Documentation of Consent

For many tests and procedures, such as routine blood tests,X-rays, and splints or casts, consent is implied. No written documentation of the consent process is obtained. For many invasive tests or for treatments with significant risk, you should be given a written consent form and a verbal explanation, both preferably in your native language.

The following components should be discussed and included in the written consent form. If they are not, you should request that information:

  • An explanation of the medical condition that warrants the test, procedure, or treatment
  • An explanation of the purpose and benefits of the proposed test, procedure, or treatment
  • An explanation or description of the proposed test, procedure, or treatment, including possible complications or adverse events
  • A description of alternative treatments, procedures, or tests, if any, and their relative benefits and risks
  • A discussion of the consequences of not accepting the test, procedure, or treatment

The consent form should be signed and dated both by the doctor and by you, as the patient. You would sign for your child. You may ask for a copy of the signed consent form.

Competency

Competency is a legal term used to indicate that a person has the ability to make and be held accountable for their decisions. The term is often used loosely in medicine to indicate whether a person has decision-making capacity, as described previously. Technically, a person can only be declared “incompetent” by a court of law.

Informed Consent, The Right to Refuse Treatment

Except for legally authorized involuntary treatment, patients who are legally competent to make medical decisions and who are judged by health care providers to have decision-making capacity have the legal and moral right to refuse any or all treatment. This is true even if the patient chooses to make a “bad decision” that may result in serious disability or even death.]

  • To document that you have been given the option of obtaining a recommended treatment or test and have chosen not to, you may be asked to sign an Against Medical Advice (AMA) form to protect the health care provider from legal liability for not providing the disputed treatment. Refusing a test, treatment, or procedure does not necessarily mean that you are refusing all care. The next best treatment should always be offered to anyone who refuses the recommended care.
  • If, because of intoxication, injury, illness, emotional stress, or other reason, a health care provider decides that a patient does not have decision-making capacity, the patient may not be able to refuse treatment. The law presumes that the average reasonable person would consent to treatment in most emergencies to prevent permanent disability or death.
  • Advance directives and living wills are documents that you can complete before an emergency occurs. These legal documents direct doctors and other health care providers as to what specific treatments you want, or do not want, should illness or injury prevent you from having decision-making capacity.