THE PRACTISE OF INFORMED CONSENT IN NIGERIA

THE PRACTISE OF INFORMED CONSENT IN NIGERIA

WHAT IS INFORMED CONSENT?

Informed consent means that the patient specifically consents to the proposed medical procedure. Informed consent is more than just consent. In order for a patient to give informed consent to a medical procedure, the health care provider must inform the patient of all of the risks and complications that may reasonably occur during that procedure, however minor they may be. Only after a patient is truly informed about the potential risks of a medical procedure can a patient give consent to the procedure.

Patient consent is not an optional extra but a core part of examination and treatment. All adults are assumed to have mental capacity to consent to or refuse treatment, unless there is evidence to the contrary.

Consent by a person with capacity is valid when it is adequately informed and voluntary. Consent merely means to agree or to permit someone to do something. It need not be in writing. As long as patients understand what is proposed, a verbal indication of acceptance is sufficient, but written authorisation is advisable for higher risk or innovative treatments and is legally required for some procedures.

The purpose of the form is to ensure that the patient gives their informed consent for the medical procedure before the procedure is performed. Current legal, moral, medical and philosophical thought lists five elements for a valid informed consent, comprising of: two preconditions: voluntarism and capacity; two information elements:  disclosure and understanding, and; a decision element: consenting or refusing.

LEGAL SUPPORT FOR THE PRACTISE OF INFORMED CONSENT IN NIGERIA

The Patients Bill of Right is an aggregation of patients rights that exist in other instruments including, The Constitution, Federal Competition and Consumer Protection Act, Child Rights Act, Freedom of Information Act, National Health Act, the Hippocratic Oath, other professional ethical codes and sundry regulations.

The bill provides for the rights, responsibility of patients and healthcare obligations. The bill provides for the right of patients to have access to all relevant information in a language that the patient understands, including complete and accurate information about diagnosis, treatment, and prognosis, other procedures and possible outcomes. The patient is to fully participate in implementing the treatment plan and making decisions.

The healthcare provider is to inform the patient about services that are available at the facility and eligibility based on health insurance or out of pocket costs and responsibilities. Equally inform patient whether proposed treatment or procedure is experimental or part of ongoing research; answer questions about proposed treatment and/or procedures and provide information about potential risks, alternative treatment and/or procedures; provide the patient’s medical records on request by the patient or other authorized persons, in accordance with prevailing laws.

Practitioners involved in procedures requiring the consent of the patient, his relation or appropriate public authority must ensure that the appropriate consent is obtained before such procedures, either for surgery or diagnostic purposes, are done, be they in invasive or non invasive.

THE PRACTISE OF INFORMED CONSENT IN NIGERIA

Consent forms should be in written form either as a part of case notes or in separate sheets with the institutions name on it. Explanations to patient from whom consent is sought should be simple and unambiguous about expectations. Proper counseling should precede the signing of the consent form. Discussion and explanation to the patient must be in the language in which the patient is fluent and when necessary through a competent interpreter.

Where the patient is under age (below 18) or is unconscious or is in a state of mind constituting a mental impairment, a next of kin should stand in. In the absence of a next of kin, the most senior doctor in the institution can give appropriate directive to preserve life. In special situations, you may need to be procure a court order to carry out life saving procedure.

The patient should know the attendant benefits and risks. Appropriate professional advice on options must be given. The preferred option is to be chosen by the patient who will then authorise the clinician by completing the form MDCN/COMEIN/R19. An essential element of good medical practice is the recognition by the attending physician of the inherent right of the patient to his own body and life.

Every healthcare provider shall give patient relevant information pertaining to his state of health and necessary treatment except in circumstances where there is substantial evidence that the disclosure of the patient’s health status would be contrary to his best interest.

The provider shall make known the range of diagnostic procedures and treatment options generally available to the patient. The provider shall also make known the benefits, risks, costs and consequences generally associated with each option and the user’s right to refuse health services and explain the implications, risks, obligations of such refusal.

WHO CAN SIGN A CONSENT FORM?

It is a trite law that only a patient can give an informed consent thus only a patient can sign the consent form.  However, notwithstanding the general rule, in some cases, another person can sign a consent form for a patient. This is appropriate in the following scenarios:

  • Age:

If a patient is a child or a young person that has not attained the legal age of making decisions, a parent or guardian will need to give consent on their behalf. The legal age of consent in Nigeria is 18.

However, despite the legal age, the healthcare providers can also consider the Gillick principle to ascertain the child’s competence. Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child under the age of 16 years is able to consent to their own medical treatment without the need for parental permission or knowledge.

  • Advance Directive:

Just like letters, they are formally written instructions appointing and signed by a patient when still very conscious and have capacity to make decisions. The appointed person has the power to give consent or make future medical decisions for the patient if they are unable to make such decision or give consent.

  • Mental Capacity:

The next of kin or the person who has been named under the advanced directive can make medical decisions if the patient can’t provide consent. This can happen if as at the time the consent is needed, the patient is of unsound mind or mentally unstable.

  • Emergency:

In an emergency situations like accident, coma etc, a close blood relatives can give the healthcare consent. But if the patient’s relatives aren’t available, a healthcare provider can perform the necessary life-saving procedures without consent.

BARRIERS TO INFORMED CONSENT IN NIGERIA

  • Gender:

A prevalent practice in certain part of Nigeria is the refusal of healthcare providers in allowing female patients to sign their consent form.  Female patients in Nigeria face a certain amount of pressure from their families when making decisions regarding their personal healthcare.

In fact, some women waive their right to make decisions, typically giving that responsibility to their husbands or fathers. In many places, consent for cesarean sections or assisted deliveries are obtained from the husband instead of the patient.

  • Literacy:

Basically, literacy is the ability to read and write.  With the high rate of illiteracy in Nigeria, its untold impact is seen in the inability of patients to understand the import of consent form. The level of education and sophistication of a culture affects the level of information disclosure that can be given to patients.

Getting informed consent from uneducated people is a regular occurrence but is more difficult and time consuming. A patient who signed an informed consent form cannot be considered informed without comprehending the medical procedure as well as its associated risks and benefits.

1. Religion:

Section 38 of the 1999 constitution guarantees a patient’s right to any religion of his choice.  This right to religion encompasses what he believes in.  Religion has had a dominant influence on ethics and healthcare practice in Nigeria.

In most parts of Nigeria, calamities, diseases, sicknesses and problems are claimed to be the direct influence of spiritual beings who may have been offended, especially if certain taboos were broken. As a result, people in remote areas are reluctant to accept Western disease models and treatment strategies.

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