Abstract
The relationship between patients and health professionals emphasizes deliberation and joint decision making, that derives in the informed consent. To evaluate decision making of patients in health care and to identify the notion of capacity for decision making, according to lawyers and physicians. A semi-structured interview about procedures to assess decision making capacity was applied to 27 selected physicians and lawyers, considering their experience in this area. A qualitative analysis of answers was performed. Several differences were observed between physicians and lawyers, probably originated in their respective disciplines as well as the context of their professional practice. For physicians the notion of capacity is associated to comprehension of the information, it is not absolute, and it must consider the intellectual maturity of the teenager and the autonomy of the elderly. This evaluation is frequently performed in the clinical interview and standardized protocols do not exist. For lawyers, capacity is established by age and is associated to rights and obligations, as determined by law. When it is assessed by experts, including physicians, it becomes evidence. These professionals assume that experts will use standardized assessment instruments. Capacity has significance in the legal system. Since there are substantial consequences when a person is deemed incompetent, it is necessary to distinguish between health capacity and legal capacity, and to inverted exclamation markink the informed consent with the fundamental rights of citizens, such as taking decisions about our own health.
Highlights
The relationship between patients and health professionals emphasizes deliberation and joint decision making, that derives in the informed consent
Los médicos que ejercen la geriatría y tienen más claridad de la vinculación que existe entre el consentimiento informado y el ejercicio de derechos de ciudadanía fundamentales, como la gestión del propio cuerpo, es decir, que del resultado de la evaluación de la capacidad de un paciente para tomar decisiones en salud, le puede quedar vedada dicha gestión, siendo entregada a otras personas que la sociedad considera, hasta ahora, «especialmente calificadas para ello»: médicos, gobernantes, sacerdotes y jueces, lo cual habla del énfasis ético
Summary
The relationship between patients and health professionals emphasizes deliberation and joint decision making, that derives in the informed consent. For physicians the notion of capacity is associated to comprehension of the information, it is not absolute, and it must consider the intellectual maturity of the teenager and the autonomy of the elderly This evaluation is frequently performed in the clinical interview and standardized protocols do not exist. En una publicación anterior[18], realizamos una extensa revisión de la reglamentación sanitaria y legal vigente en Chile en torno al tema de la capacidad, con relación a los menores de edad, ancianos y enfermos mentales, marco que ha guiado el planteamiento del presente estudio. Contiene una serie de preguntas abiertas destinadas a entregar el encuadre para la entrevista y a focalizar la recolección de los datos de interés y la segunda, contiene una escala de diferencial semántico, cuyo propósito es examinar las actitudes y significados asociados a un objeto, en este caso «los procedimientos para evaluar la capacidad». CAPACIDAD DE LA PERSONA EN TOMA DE DECISIONES EN PRÁCTICA MÉDICA Y LEGAL - G Bórquez et al
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