Gastrointestinal Prosedürlerde Onam Esnekliği Yönetimi

Abstract

Not being able to provide informed consent with a competent decisional capacity put the productive patient-doctor relationship at stakes. Although, decisional capacity is not a binary, all-or-nothing phenomenon, it is up to the physicians to decide on behalf of their patient whether they opt in or out of autonomy. The objective was to explore this dilemma in medical ethics and analyze the issue of consent-elasticity under the medico-legal system in Turkey. A representative quota sample of 15 adults hospitalized for gastrointestinal diseases with impaired decisional capacity were included. From a legal/ethical point of view, a 5-layer model of risk stratification have been proposed and 3 best representing cases were matched with each level. In Turkey, the statute of patient rights and Oviedo Convention explain the circumstances under which informed consent can be waived in adult patients. Related terms from these legal measures set the tone for the model in the management of consent elasticity. The doctor-patient concordance decreases as the degree of risk increases and the tendency to seek a regulatory mechanism for mediation in crisis resolution becomes even more evident. The model creates a basis for structured management of consent-elasticity in gastrointestinal procedures and secure the shared decision making and doctor-patient concordance. Yet when a high-risk situation is identified and the clinical strategy appears to be backfiring, consulting the bioethics committee, the administrative person or body and sometimes a colleague is a reasonable and a highly efficient way to elucidate the ethical norms relevant to the case.