Culture within Informed Consent:Papua New Guinea Perspective

This paper examines informed consent in medical practice.We have explored the notion of consent and determined its underlying theory and important attributes.We argue that consent is a permissive state of mind that waives the right to bodily integrity.Once communicated to the actor the permission takes effect by justifying the intervention and legitimizing the virtuous exercise of the doctor’s power.The process is usually formally documented by the reading and signing of a“consent form”by both the patient and the doctor who is proposing the treatment that takes place within a clinical setting.Many people grow up in the traditional communities where the idea of informed consent is undeveloped and tend to be passive in their roles in the informed consent process.We have gathered from this study that people tend to stick to their traditional customs and custom has become a source of their rules,brings people together,shares food,and uses for resolving issues in family,land,water rights,and compensation following disputes.In other words,peoples’ways of life revolve around their traditional customs.Family wellbeing decisions and especially health care are usually a family matter but not an individual.Going to receive health care services at the hospital or modern health care center for medical treatment is enough to make a patient say they do not want to follow through the clinical procedure including the process of informed consent.A medical consent form is a common form used in health care facilities to obtain medical consent for a certain treatment or medical procedure or dental.We found in the interview questionnaires that many patients do not understand the use of consent forms.We examined informed consent in the context of the people’s culture and how the healthcare professionals handle the situation with patients that have widespread customs,beliefs and opinions which they strictly adhere to and practice.

Knowledge,Awareness,and Attitude of Doctors and Patients regarding Informed Consent to Medical Procedures in Papua New Guinea

This study explores how doctors and patients in Papua New Guinea(PNG)perceive informed consent in medical settings.Doctors and patients from National Capital District and Central Province who responded to the survey were the participants of the study.Researchers asked the participants to fill out questionnaires regarding their knowledge about informed consent for each group,namely,the doctors and participants.From those who responded,six randomly selected participants were chosen to join the focus group discussion which aimed to get experiences from the doctors and patients regarding medical procedures.Results show that both doctors and patients lack knowledge of the legalities of informed consent.Based on the experiences of doctors,they do not use consent forms when seeking permission from patients.Patients,on the other hand,do not see consent forms as important and only served as a formality.Customs,culture surrounding PNG were found to have an impact on how patients perceived informed consent.

Physicians’Perspectives of Informed Consent for Medical Procedures:A Qualitative Interview Study

This work is based on an on-going research on medical informed consent in Papua New Guinea(PNG)with 19 doctors from hospitals,health care centers and private medical establishments in the National Capital District and Central Province who voluntarily participated in the study.The authors conducted an examination of doctors’understanding of informed consent for medical procedures through a qualitative interview study and we describe our findings.We saw a need to involved patients in decision-making about their care,ethical imperative and concerns about litigation and their complaints highlighted the issue of informed consent.In order for the patients to make an informed decision about medical procedure,the doctors involved in the proposed treatment should conduct the informed consent discussion.The discussion should include the treatment,the risks and benefits of treatment,and alternative therapies with associated risks and benefits.We studied doctors’perspectives of gaining informed consent for routine medical procedures.We used qualitative study methods using structured interviews selected by purposive sampling.The data collected were entered into a data base and were analyzed thematically.The discussion is based on review of legal decisions,commentaries and our personal experience in studying medical malpractice cases.We have utilized case reports and several informative writings that have appeared in the world literature,as well as selections from vast amounts of material available in USA,UK,Australia,India and PNG.The current informed consent processes do not appear to be ideal for many doctors in PNG.In particular,there are inhibiting factors that affect patients from making medical informed decisions,doctors find time not enough to run discussions on informed consent,Department of Health does not have a standard informed consent form,patients complain about no consent form,and they have not signed consent forms.These are but some issues that affect patients when trying to make informed decisions.We say that informed consent process flows from the relationship between doctor and patient,however when this does not occur,serious legal and ethical consequences may result.This report is not intended to be specific advice on any private legal matter.

The Duty of States to Give Sufficient Recognition to the Right to Health

Modern human rights,as they have developed since World War II,have several characteristics that are imperative to how they are viewed.They are universal,indivisible,interdependent and interrelated.That is,they are held by all people by virtue of the fact that they are human,and apply to all people everywhere.Not all human rights are absolute.That is,some are considered“qualified rights”which may be subject to lawful interference.In the Papua New Guinea(PNG)context,interference will be lawful if it is prescribed by law consistent with the national Constitution and necessary to protect either the rights of others or for other considerations,such as national security,public order or public health.In the ending of life context,the weight that should be given to the consent to,and refusal of,treatment in circumstances where the decision will lead to the death of a patient is debated.This leads to another concern which is the way in which the prerequisites for a refusal of treatment(or valid consent)have been construed.The requirements of competence,voluntariness and information-giving arguably come under more intense scrutiny where the ramifications of the decision have such grave consequences.This paper considers consent as a reflection of the ethical principle of respect for personal autonomy that is often expressed in the law as the principle of self-determination.It also reviews the experiences of healthcare professionals who guide an informed consent process made by individuals,spouses,family members and advisors for the loved ones whose sickness,injury or geriatric age prevent them from having decision-making capacity.The last part summarizes the understanding of the nature of the procedure,benefits and risks which are important to informed consent and offers suggestions as to how the situation can be remedied.

Respect for Patients’ Right to Autonomy

In this review article we examine the laws and rulings regarding informed consent.It is well known that the patient must give valid consent to medical treatment;and it is his or her prerogative to refuse treatment even if the said treatment will save his or her life.No doubt this raises many ethical debates and falls at the heart of medical law today.There is widespread refusal of or withdrawal from medical treatment by patients suffering from illnesses,including communicable and non-communicable diseases.In Papua New Guinea(PNG)while a patient has a right to refuse treatment,there is no legal right to demand treatment.The paper seeks to clarify the nature,extent and importance of a patient’s right to respect for autonomy from the practitioner.We will attempt to conceptualise the patient’s autonomy by exploring the legal framework of consent or more specifically informed consent.Where the law of PNG differs from the laws of other parts of the world we have focused on the laws of the former.The legal aspects and guidance by the regulatory authorities apply only to PNG.

The Landscape of the Legal Aspects of Informed Consent for Medical Treatment in Papua New Guinea

The major challenges militating against the proper practice of informed consent identified in our desk top review are related to cultural issues of the people.Many patients continue to value strongly their kinship ties with the past and believe in the traditional methods of healing sickness.The patients must be given some information about what the doctor proposes to do.The underlying spirit of informed consent is new in PNG,and it strives against the traditional attitudes of doctors that they know it best for the patients and the strong culture in customs and patients’misconceptions that affect their perceptions in making important health care decisions.Majority of the patients have some notion of informed consent,however not many people understand what it is.They still hang onto their traditional customs,beliefs and opinions that affect their health care decisions;they often look to their village elders,family and parents for advice in times of sickness or death in the family but where the law implies consent it is not often obtained.Summarization of current laws,reports of legal cases,and personal experiences were examined.Special requirements must be prescribed when patients are subjected to medical treatment.Documentation of a well-defined process,not only on paper,may not only protect the medical doctor from exposure to liability but increases the patient’s autonomy in decisions concerning health and encourages compliance with treatment;and advances the interests of both patient and doctor.Lack of informed consent can reinforce a claim of medical malpractice,and could well undermine relevant health care policy to protect patient autonomy.

Customary Law to Acquire Full Force of Law

A number of the constitutions limit recognition of customary law to those customs and/or usages,which have the“force of law”in their respective territories.The question as to whether a custom has the“force of law”may be variously interpreted depending upon whether it is the community,the courts,or the legislature,which has the power to identify when a custom becomes law.Determining just when a custom acquires the“force of law”is of much importance for its wider recognition and application.This in turn is linked to the question of proof of customary law.A key aspect of Papua New Guinea(PNG)’s approach is that it brought the multiplicity of regimes of different cultures under a national framework and has given a place to customary law which is now constitutionally recognized as superior to the inherited common law.It places the local and traditional over the inherited and imported law,with the constitution placed over both.In this paper I examine customary law as in the context of the PNG Constitution.