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Master Thesis

Décision médicale et consentement du patient âgé atteint de troubles cognitifs légers à modérés

Abstract : A great number of publications in the scientific literature concerns issues surrounding consent in the elderly with cognitive impairment. The presence of these cognitive disorders could impact the individual’s reasoning abilities and compromise informed consent as it is required by the legislation. In order to assess this ability to consent, theoretical models - what the purpose of consent would be and what it presupposes - as well as standardized assessment tools were developed. Nevertheless, some limitations reduce their applicability. These limits question the adequacy of consent between theory and practice. It may be necessary to leave this term aside for a while and see if its aim is, in a sense, pursued. Involving the patient in the development of a medical decision is one of the purposes of consent. How do physicians involve the elderly patient with mild to moderate cognitive impairment into this decision-making process? This qualitative study conducted with general practitioners and geriatricians attempts to understand the vision of these health professionals on this issue. The term of adhesion or assent is used rather than the notion of informed consent by the interviewed physicians. Reluctance or refusal of the patient to a medical decision is a rare and globally accepted situation. Occasionally, circumstances require the physician to strengthen the medical decision’s argumentation: a perceived danger, risk or urgency, a difference of opinion between the doctor, the patient and his family, an absence of knowledge by the patient of his cognitive disorders, a low capacity of listening by the doctor, the conviction of a favorable result if the medical decision is followed. In all situations, doctors attach great importance to create and maintain a relationship with the patient. This dissociation between theory and practice provides interesting insights into the difficulties of applying informed consent in medical practice.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02515240
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  • HAL Id : dumas-02515240, version 1

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Arthur Tron. Décision médicale et consentement du patient âgé atteint de troubles cognitifs légers à modérés. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02515240⟩

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