Promoting and Respecting Informed Decision-Making

Nurses recognize, respect and promote a person’s right to be informed and make decisions (CNA, 2007). The principle of autonomy and to respect a person is imperative and that everyone has a fundamental right to self-determination that is limited only by unjust infringement in the rights of others. The informatics version of the principle goes as follows: ‘The electronic patient record should be treated never as a mere thing but always as a person-analogue in information and decision-space’ (Kluge, Eike-Henner W., 2003, p230). Access to electronic health records (EHR) is the electronic equivalent of material access to the person who is the subject of this record.
As mention above not all patients fall into the category of the assumed competent patient. Some are incompetent and fall into several sub-categories such as children, the congenitally incompetent, and the incompetent patients who previously were competent. The patient engages the health care system on a voluntary basis and the normal informed consent protocols apply. However, these protocols can be inappropriate for the emergency patients who are cognitively or volitionally compromised and are unaccompanied by duly authorized decision makers. This has informatics’ implications.
The appropriate health care cannot be delivered without developing or accessing the electronic health record and sharing of information with relevant stakeholders. Therefore an ethically structured security protocol must include routines that identify not only the competence status of the patients but also their mode of entry so that the relevant provisions can be engaged (Kluge, 2003). With the sharing of the EHR, cross border health encounters and information sharing among the provinces and territories will bring into question the current licensure practices of informed consent as well as liability with remote access to the EHR.
Informed consent is a process. Therefore it must meet certain criteria. The clients of EHR have a right to informed consent. In order to ensure that the conditions are being met it may be appropriate to establish a trusted and certification authority whose role would be to ensure that the security structures and protocols meets high-level policy requirements and standards (Kluge, 2003).