Our study shows that physicians do not have insufficient knowledge of consent and confidentiality laws. Compared to other studies of physicians` knowledge of various aspects of the law, our respondents` overall score was slightly lower [11]. The privacy score of 1.53 out of 3 is consistent with Karasneh`s (7 out of 14), but lower than Beltran Aroca (6.8 out of 10) and Tegegne (3.91 out of 7) [8, 12, 13]. In order for you to give informed consent for treatments or tests, the doctor or health care provider must give (or disclose) enough information to help you make an informed decision. It is not necessary or expected that you receive all the details of the test, treatment or procedure. You just need the information expected of a reasonable person to make an intelligent decision. This information should include the risks and probability (or probability) of each of the risks and benefits, as well as the probability (or probability) of the benefits. Any questions you have should be explained in detail, in language and terminology you can understand. At the age of 16, persons are considered to be of legal age and may therefore be considered legally competent. Children under the age of 16 may be able to behave according to their understanding. If a competent child refuses treatment, persons exercising parental responsibility may authorise it or a court may annul the child`s decision.3 Incapacitated children shall be treated with the consent of a person exercising parental responsibility. Most authors describe consent as a relatively new principle in medicine.4-6 This is incorrect, however, as even Plato and Hippocrates used consent in their medical practice.7 More recently, the debate has been revived by the recognition that modified and abandoned consent models are fundamental to the successful development of a „learning health system“; a concept first proposed by the Institute of Medicine28, in which knowledge generation processes are integrated into daily practice in order to continuously improve care and add value. Essentially, changing or waiving consent would reduce disruption to normal clinical workflows and make integrating trials into mainstream practice much more convenient.
As a result, a number of groups have considered how informed consent could be adapted in such a health system. Kim and Miller propose a model that integrates research consent into routine clinical discussions with patients.29 Modi et al. advocate systematic randomization as the default position and advocate modified consent.23 Myles et al. adopted a modified consent model that excludes post-randomization from further participation.24 Finally, Faden et al. propose a new ethical framework, where rigorous and systematic assessment is considered part of normal practice and patients and the public are better informed and accept that, in certain circumstances, individual consent cannot be obtained.30 Of the 305 respondents, 275 reported never breaking the law. However, their median score for the correct answer was 5.35 ± 1.66 out of 10. Specialty was the best predictor of legal knowledge, with emergency physicians scoring the lowest and non-surgical physicians the highest. Physicians working in both the private and public sectors were better informed about legal issues than those working exclusively in the public sector. The results suggest that physicians are aware of the patient`s right to informed consent, but do not have a comprehensive understanding. While most doctors answered simple questions correctly, only a tiny minority identified the right solution to ethical dilemmas. Doctors who acknowledged a violation of the law, on the other hand, had a slightly higher knowledge value of 5.45 ± 2.18. The 21st Century Cures Act, passed in December 2016 by 114.
The U.S. Congress allows researchers to waive the requirement for informed consent when clinical trials „pose minimal risk“ and „include adequate safeguards to protect human rights, safety, and well-being.“ [9] In England and Australia, the limited use of modified and revoked consent may be due in part to the lack of clear guidelines specific to the study. In both countries, it is up to investigators and ethics committees considering the use of these models to interpret a range of laws. In order to establish a defensible position, they must „break down“ informed consent into its components: (1) consent to data processing; (2) consent to treatment: and (3) consent to participate in a study. In both countries, there are mechanisms that allow for a waiver of consent to the processing of data for research purposes. In both countries, there are common law requirements for consent to treatment, which require disclosure of significant risk and reasonable alternatives that would reflect what would have been appropriate outside the study setting for pragmatic studies. In order to waive consent to disclose study participation, the common law requires patients to understand the nature and purpose of the treatment offered. If patients are not informed of the purpose of the research in the individual studies (i.e. generating better evidence through `randomisation`), patient involvement through study awareness activities should be considered.
For example, wide-ranging the reasons and arguments of an institution for integrating trials into routine care would increase awareness that studies are conducted primarily to improve care. If patients understand and accept that the objectives of research (knowledge production) and clinical care objectives (patent processing) converge, the risks associated with non-disclosure of the research component of treatment and its negative impact on patient autonomy would be minimized. In addition, analysis of responses to patients without decision-making capacity showed that physicians have limited understanding of applicable laws, both in emergency and non-emergency scenarios. According to Romanian law, a substitute decision-maker must be found if a patient is unable to make medical decisions.