2024-04-30 10:06:44
The Ethics Committee of the French Hospital Federation has just published one Notification of consent to care : “Put the patient in a position to consent to care with full knowledge of the facts”. It emphasizes the crucial importance of the patient’s consent, while at the same time identifying challenges in implementation, and in particular the need for adaptations, especially in complex contexts such as impaired judgment or cognitive pathologies, by favoring a longer and informed process.
In his newspaper, The FHF’s ethics committee emphasizes the importance of patient consent, but identifies challenges in implementation, especially its impersonal approach and little adaptation to the patient’s distinctive character, as mentioned in Statement 142 of the National Ethics Advisory Council (July 2021). It specifies the imperative to adapt this approach, especially in complex situations such as impaired judgment or cognitive pathologies, considering reversibility and the need for longer time to obtain free and informed consent while ensuring the delivery of correct information.
“The interest of a good understanding of the issues of co-determination and the favorable condition of the patient to obtain his wishes is likely to promote the therapeutic alliance. »
At the same time, he clarifies that some patients can feel helpless when faced with complex care sequences requires a need for clearer communication and support in decision-making. Healthcare teams must therefore work with patients and those around them to ensure understanding of medical information and therapeutic implications, emphasizes the importance of informed consent in healthcare practice.
« Cet newspaper encourages reflection and discussion at the workbenchespphealth issues about the nature of consent, both in the most trivial day-to-day care, where it is informal but crucial, and in complex situations where it is essential.«
The FHF’s ethics committee therefore sees the need to put co-development of consent at the center of practice caregivers and institutions within the public hospital: it is necessary to reconceptualize autonomy of consent as a developed skill rather than an innate capacity, fostered in a caring environment and encouraged by health professionals, emphasizing its relational aspect. Shared medical decision-making must be favored, takes into account the patients’ needs and priorities, and including their active participation in the consent process.
Temporality of consentThe opinion must also be reviewed and adapted to the patients’ individual needs to let them define their preferences and avoid hasty decisions, especially in the context of chronic pathologies with different temporal conditions. Consent, an act of care in itself, can be expressed explicitly or implicitly, but is still essential to ensure that care is fair and appropriate for the person being cared for.
“Consent is an act of care in the same way as a diagnostic or therapeutic act. Consent is support for the realization of the just necessity of care, of the act of care that is proportional and adapted to the patient’s existence, which can be confirmed by the trusted person who is engaged in a relationship to carry the patient’s word and his will. . »
The FHF’s ethics committee therefore recommends:
– to place joint development of consent at the heart of health services;
– to favor shared medical decisions;
– to adapt the timing of the consent to the patients’ individual needs.
• CCNE Opinion 136 “The evolution of ethical issues related to consent in health care”, 7 July 2021 (PDF)
• « Place the patient in a position to consent to care with full knowledge of the facts”. Statement by the Ethics Committee of the French Hospital Federation. Dr Cyril Hazif-Thomas, psychiatrist, Julia Tinland, philosopher and the ethics committee of the FHF, March 2024.
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