Contemporary models for realistically achievable consent and capacity assessment in primary care

Abstract: The processes of informed consent and assessment of medical decision-making capacity described by bioethicists, attorneys, and medical scholars differ from the realities of everyday primary care practice. This workshop will present two published models reconciling the gap between the theory and practice of consent in primary care. Two mini lectures and case-based small group discussions will introduce these models to participants.

First, the consent continuum will be presented as a means of consciously considering the risk and nature of an intervention to decide whether it is more appropriate for a process of non-dissent, active assent, or formal informed consent. Cases for discussion include various office procedures, pelvic-GU-rectal exams, and medication prescription such as antibiotics, antipsychotics, opioids, and GLP-1 diabetes/weight loss medications.

Second, the assessment of medical decision-making capacity will be described as an iterative activity that can only be performed during the process of informed consent—deliberately, even if only very briefly—not prior. Participants will consider cases including an 18-year-old requesting ADHD medication, a 60-year-old with a history of substance use, mood, and chronic pain disorders endorsing chest discomfort, and an 84-year-old with memory concerns declining evaluation.

This workshop concludes with ample large group discussion addressing barriers and solutions to implementing these models in the context of what is realistically achievable in primary care settings.

The presenters are three primary care educators from across the country with backgrounds in bioethics (HEC-C), medicine (MDs), and philosophy (PhD), and a medical student who is a former state legislator and cancer patient.

Keywords: informed consent, medical decision-making capacity, primary care ethics