My opinion
 

By Dr. Deepak Gupta , Dr. Nida Aftab
Corresponding Author Dr. Deepak Gupta
Wayne State University, - United States of America 48201
Submitting Author Dr. Deepak Gupta
Other Authors Dr. Nida Aftab
Detroit Medical Center, Anesthesiology, - United States of America

ANAESTHESIA

Anesthesia Consent, Audio-Video Recording, Air-Gapped Devices

Gupta D, Aftab N. Audio-Video Recording The Consenting Process With Futuristic Air-Gapped Dedicated Devices. WebmedCentral ANAESTHESIA 2018;9(5):WMC005462

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
No
Submitted on: 12 May 2018 01:27:35 PM GMT
Published on: 15 May 2018 07:40:57 AM GMT

Opinion


As anesthesiologists working in perioperative areas, the question that constantly lingers is how to judge the capacity of perioperative patients to consent for the procedures they are presenting for and the procedures they may need emergently. Even though these questions might not have been traditionally related to anesthesiologists' responsibilities, the evolution of anesthesia specific consenting process as well as consents for anesthesia specific procedures warrants the understanding of patients' capacity to consent [1-4]. Even though innumerably times reiterated and still easily forgotten, patients' incapacitation to consent for specific procedures/processes is different from patients' legal incompetence that results in an almost-blanket transfer of all decision-making via legal authority delegating it to dedicated surrogates/legal guardians who all themselves in turn should have the capacity to consent for specific procedures/processes on the behalves of the patients [5-12]. Therefore, the evaluation of patients' (and potentially even of surrogates'/legal guardians') capacity to consent is part and parcel of consenting process which all anesthesiologists will eventually be exposed to and therefore have to be attuned to. Simply stating, this evaluation encompasses posing questions which quiz the patients' capacity to understand the clinical scenarios they are in with the options which lie ahead for them, their capacity to appreciate the implications of their current clinical scenarios, their capacity to reasonably differentiate among the options they have to deal with their current clinical scenarios and thereafter their capacity to reasonably decide and choose their best-possible options based on their appropriate understanding, appreciation and reasoning about their current clinical scenarios. Since there are semi-structured interviews [5] based on the templates and possible inspirations from MacArthur Competency Assessment Tool {for Treatment (MacCAT-T) [13] and for Clinical Research (MacCAT-CR) [14]} or from Assessment of Capacity for Everyday Decision making (ACED) [15] with Short Portable version of ACED (SPACED) [16] for these evaluations about capacity to consent, it will be worthwhile to consider adding the audio-video recordings [6, 17, 18] into these consenting processes, at least for elective (clinical and/or research) processes wherein the futuristically air-gapped smart devices [19] dedicated solely for the audio-video recordings of these consenting processes can be used for secure storage so that these recordings can be replayed and reviewed during the recurring visits of the patients prior to the commencements of their consented procedures and thereafter the new concerns can be answered which may have arisen since the initiation of the consenting processes, thus providing the patients with the opportunity to reconsider their options any number of times before the commencements of the consented procedures. Moreover, these audio-video recordings on dedicated air-gapped smart devices will possibly accrue medicolegal value across the spectrum of consenting processes wherein at one extreme, the wronged patients will have legal protection against incompletely performed consenting processes while at the other extreme, the wronged providers will have legal protection against malicious litigations based on fabricated evidences. Due to the possibility of medicolegal importance [20-21] being accrued to these audio-video recordings, it will eventually lead to their inclusions into continuing medical education curriculums with the aims at comprehensively driving the informed consent processes towards the levels of ideological perfections while providing medicolegal protection to both patients and providers in the events of potentially failed and/or presumptively failed informed consent processes. Summarily, before they become mandatory educational exercises as well as clinical exercises in themselves, the anesthesia providers should explore, review and ponder how to judge their patients' capacity to consent for anesthesia and related procedures and must be able to logically answer questions and concerns about semi-structured interviews based assessments of their patients' capacity to consent, especially when these questions and concerns are related, but not limited, to (a) ongoing or new-onset pathophysiology dynamically affecting their patients' capacity to consent and/or (b) administration of scheduled home doses or recently prescribed doses of potentially cognition-impairing medications like analgesics, anxiolytics and sedatives.   

Reference(s)


  1. American Society of Anesthesiologists. Frequently asked questions on informed consent for procedures. Accessed on February 10, 2018. www.asahq.org/~/media/sites/asahq/files/public/resources/faq-anesthesia-consent-ver-1-5.pdf
  2. American Association of Nurse Anesthetists. Informed consent for anesthesia care: Policy and practice considerations. Accessed on February 10, 2018. https://www.aana.com/docs/default-source/practice-aana-com-web-documents- (all)/informed-consent-for-anesthesia-care.pdf
  3. Yentis SM, Hartle AJ, Barker IR, Barker P, Bogod DG, Clutton-Brock TH, Ruck Keene A, Leifer S, Naughton A, Plunkett E. AAGBI: Consent for anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2017 Jan;72(1):93-105. Accessed on February 10, 2018. http://doi.org/10.1111/anae.13762
  4. Yaddanapudi S. Not just a separate consent for anesthesia! J Anaesthesiol Clin Pharmacol. 2017 Jan-Mar;33(1):1-2. Accessed on February 10, 2018.  http://doi.org/10.4103/joacp.JOACP_364_16 https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC5374807/
  5. UpToDate. Assessment of decision-making capacity in adults. Accessed on February 10, 2018. https://ww w.uptodate.com/contents/assessment-of-decision-making-capacity-in-adults
  6. Grady C, Cummings SR, Rowbotham MC, McConnell MV, Ashley EA, Kang G. Informed Consent. N Engl J Med. 2017 Mar 2;376(9):856-867. Accessed on February 10, 2018. http://doi.org/10.1056/NEJMra1603773
  7. Atluru A. Revisiting Decision-Making Capacity. American Journal of Psychiatry Residents' Journal. 2016 Nov 1;11(11):11–2. Accessed on February 10, 2018. https://ajp.psychia tryonline.org/doi/full/10.1176/appi.ajp-rj.2016.111105
  8. Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity? JAMA. 2011 Jul 27;306(4):420-7. Accessed on February 10, 2018. http://doi.org/10.1001/jama.2011.1023
  9. Appelbaum PS. Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med. 2007 Nov 1;357(18):1834-40. Accessed on February 10, 2018. http://doi.org/10.1056/NEJMcp074045
  10. Huffman JC, Stern TA. Capacity Decisions in the General Hospital: When Can You Refuse to Follow a Person's Wishes? Prim Care Companion J Clin Psychiatry. 2003 Aug;5(4):177-181. Accessed on February 10, 2018. https://www.ncbi.nlm.nih.gov/pmc/article s/PMC419388/
  11. Leo RJ. Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians. Prim Care Companion J Clin Psychiatry. 1999 Oct;1(5):131-141. Accessed on February 10, 2018. https://www.ncbi.nlm.nih.gov/pmc/article s/PMC181079/
  12. Society of Hospital Medicine. The Hospitalist. How do I determine if my patient has decision-making capacity? Accessed on February 10, 2018. https://www.the-hospitalist.org/hospitalist/article/124731/how-do-i-dete rmine-if-my-patient-has-decision-making-capacity
  13. Professional Resource Press. MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Accessed on February 10, 2018. http://www.prpress.com/MacArthur-Competence-Assessment-Tool-for-Treatment-MacCAT-T_p_169.html
  14. Professional Resource Press. MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). Accessed on February 10, 2018. http://www.prpress.com/MacArthur-Competence-Assessment-Tool-for-Clinical-Research-MacCAT-C R_p_167.html
  15. Lai JM, Gill TM, Cooney LM, Bradley EH, Hawkins KA, Karlawish JH. Everyday decision-making ability in older persons with cognitive impairment. Am J Geriatr Psychiatry. 2008 Aug;16(8):693-6. Accessed on February 10, 2018. http://doi.org/10.1097/JGP.0b013e31816c7b54 https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC2730037/
  16. Jason Karlawish. The Assessment of Capacity for Everyday Decisionmaking (the ACED). An instrument that puts assessment into our ethics and ethics into our assessments. Accessed on February 10, 2018. http://jasonkarlawish.com/articles/assessment-capacity-everyday-de cisionmaking-aced-instrument-puts-assessment-our-ethics-and-
  17. Chauhan RC, Purty AJ, Singh N. Consent for audio-video recording of informed consent process in rural South India. Perspect Clin Res. 2015 Jul-Sep;6(3):159-62. Accessed on February 10, 2018. http://doi.org/10.4103/2229-3485.159941 https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC4504058/
  18. Kulkarni NG, Dalal JJ, Kulkarni TN. Audio-video recording of informed consent process: Boon or bane. Perspect Clin Res. 2014 Jan;5(1):6-10. Accessed on February 10, 2018. http://doi.org/10.4103/2229-3485.124547 https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC3915373/
  19. CBS Interactive. TechRepublic. 6 ways to secure air-gapped computers from data breaches. Accessed on February 10, 2018. https://www.techrepublic.com/article/6-ways-to-secure-air-gapped-computers-from-data-breaches/
  20. Pennsylvania Coalition of Nurse Practitioners. PA Supreme Court narrows informed consent requirement. Accessed on February 10, 2018. ht tp://www.pacnp.org/news/353079/PA-Supreme-Court-Narrows-Informed-Consent-Requirement.htm
  21. Chan SW, Tulloch E, Cooper ES, Smith A, Wojcik W, Norman JE. Montgomery and informed consent: where are we now? BMJ. 2017 May 12;357:j2224. Accessed on February 10, 2018. http://doi.org/10.1136/bmj.j2224  

Source(s) of Funding


NONE

Competing Interests


NONE

Reviews
0 reviews posted so far

Comments
0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.

 

Author Comments
0 comments posted so far

 

What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
Where
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)