Core IM | Internal Medicine Podcast #71 Capacity Part 2, Voluntarism & Difficult Scenarios: At the Bedside Segment
Jul 22, 2020
Dr. Cindy Geppert, a consultation-liaison psychiatrist and palliative care clinician with 20+ years doing capacity evaluations, joins to unpack voluntarism. They outline factors that erode voluntarism, practical impacts on consent, and tricky bedside scenarios like uncooperative or unrepresented patients. Conversation also covers clinician bias, moral distress, and approaches when decisions clash with medical recommendations.
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Voluntarism Is The Third Pillar Of Informed Consent
- Informed consent requires not just information and capacity but also voluntarism to ensure choices are free from coercion.
- Cindy Geppert highlights voluntarism as the missing third pillar that makes decisions genuine and aligned with values.
Four Domains That Shape Voluntarism
- Laura Roberts' four domains shape voluntarism: developmental, illness-related, psychological/cultural/religious, and external pressures.
- Examples include adolescents' immature identity, withdrawal reducing freedom, cultural admission harms, and homelessness.
Cultural Humiliation Destroyed A Patient’s Voluntarism
- Geppert recounted a young Hindu woman who was humiliated when admitted in a gown among men, eroding her voluntarism despite intact cognition.
- The cultural violation triggered hysteria and restraints, showing voluntarism can be destroyed by environment.