Informed Consent, Confidentiality, and Patient Record-Keeping

 Informed Consent, Confidentiality, and Patient Record-Keeping

Health workers think that when patients seek competent help from them, it is assumed that the burden of carrying the sickness outweighs an individual and on their own they have no control. Indeed, the sick person has an obligation to seek technically competent help and they have to cooperate with the health worker (physician according to Talcot Parsons, 1951). The patient’s obligation to seek competent help may find its counterpart in the doctor’s obligations to be solely guided by the welfare of the patient (Parsons, 195la: 438, 477). Likewise, as counterpart of the patient’s obligation to get well, Parson’s frequent reference to the need that the doctor must apply the highest possible standards of technical, competence and scientific knowledge may indicate a role obligation (Parsons, 1951a: 437). Thus the two duties making up the doctor’s role are those to serve but the patient’s welfare, and to ensure that this is done with the utmost professional competence. It is more difficult, however, to determine the two rights of the health worker. If they are to be symmetrical to those of the sick role, then the doctor ought to have rights of exemptions and obligations. The rights are therefore (i) the right which is granted to the doctor is that he has to ‘enter’ every sphere of a person’s body or life story or highly guarded taboo spheres and (ii) to render therapeutic help according to the dictates of science.

 Parsonian Healing Role

 

It appears from the Parsonian point of view that doctors do not need to have any consent in entering the private sphere of patients who may have a mental disorder and further no confidentiality may be needed throughout the course of a relationship. Although the clinical training of health workers does not deal in sufficient detail with human rights involving persons with mental disorders, health workers are frequently unaware of these patients’ rights and thus unable to put them into practice. It is therefore essential that our clinical practice includes the act of informing patients of their rights. We ought to remember that most persons with mental disorders retain the ability to make informed choices and decisions regarding important matters affecting their lives. However, there are circumstances in those with severe mental disorders, this ability might be impaired. In these circumstances, we ought to have a sixth sense to allow us managing the affairs of people with mental disorders in their best interests while ensuring that others (near relatives) or a friend or legal counsel instead are informed and consent.

 Informed Consent and Confidentiality

 

Therefore, every mental health consumer should be unreservedly regarded as a citizen and should be informed and consulted about any clinical decision during the different stages of the treatment process.

Noting that there will be a law passed addressing issues of confidentiality and informed consent; it will be prudent to be conversant with the provisions in the legislation. What is medically prudent is as follows:

No examination and treatment should be given to a patient without his or her informed consent. To be valid, consent must satisfy the following criteria.

a)               Consent should be obtained freely, without threats or improper inducements.

b)              There should be appropriate and adequate disclosure of information on the purpose, method, likely duration and expected benefits of the proposed examination and treatment.

c)               Possible pain or discomfort, risks and the likely side-effects of the proposed examination and treatment should be adequately discussed with the patient.

d)              Choices should be offered. Alternative modes of treatment, especially ones that are less intrusive should be discussed and offered to the patient.

e)               Information should be provided in a language and form that is understandable to the patient.

f)                The patient should have the right to refuse or stop treatment.

g)               The consequences of refusing treatment should be explained to the patient.

h)              Where consent cannot be obtained from a person, especially one who has a severe mental disorder, attempts should be made to obtain it from a near relative or a friend or legal counsel.  

i)                Ensure that consent becomes part of the patient’s record.

Concerning confidentiality, remember that confidentiality belongs to the patient, not the professional. In no event, however, shall privileged communications, whether written or oral, be disclosed to anyone without such written consent first from the patient and second from near relatives or friend or legal counsel when the patient is in no position to consent. We should try by all means to ensure that all documents concerning persons in treatment are kept confidential and, without the person's written consent, may not be released or their contents disclosed to anyone except as directed by the in charge of a mental health facility and in circumstances permitted by law.