Chapter 1 THE PROBLEM AND REVIEW OF RELATED LITERATURE AND STUDIES

Introduction

Personal autonomy encompasses, at a minimum, self-rule that is free from both controlling interference by others and from certain limitations such as an inadequate understanding that prevents meaningful choice. (Beauchamp and Childress 2008)

Informed consent is more than simply getting a patient to sign a written consent form. It is the process by which a fully informed patient can participate in choices about his health care. It originates from the legal and ethical right the patient has to direct what happens to his body and from the ethical duty of the physician to involve the patient in his health care (K. Edwards, 2008). Comprehension on the part of the patient is equally as important as the information provided. The informed consent doctrine has become a foundational precept in medical ethics and health law. Although it was practiced, it rarely achieves the whole contexts of the informed consent process. It has been implemented worldwide. And an optimal establishment of an informed consent requires adaptation to cultural or other individual factors of the patient. Legally, simple consent protects patients against assault and battery in the form of unwanted medical interventions (CMAJ, 2012). The patient must have been given an adequate explanation about the nature of the proposed investigation or treatment and its anticipated outcome as well as

the significant risks involved and alternatives available. Aside from the protection it serves, patients exercised their autonomy independently. Worldwide, twenty-five hundred years of Western medicine, starting with Hippocrates, have been built on the preferred conception that physicians should protect their patients from information about their diseases or treatment options. The Patient Self-Determination Act (PSDA) was passed in 1990 and went into effect in December 1991. The essence of this legislation is to empower the public with the right to be fully informed and fully self-determining regarding end-of-life decisions. However, since its implementation there is little evidence of national acceptance by the health care industry. The law applies to all health care facilities that receive any federal reimbursement for services, and includes hospitals, nursing homes, home health agencies, and clinics. The PSDA requires a health care mechanism for disseminating information about advance directives with patients (R. Pear, 2010). The time honored relationship between Filipino physicians, their patients and the community has undergone significant changes in recent times. A law has been passed on July 01, 2004 declaring the rights and obligations of patients and establishing a grievance mechanism for violations thereof and for other purposes. House Bill 261, Title III: Declaration of Rights presents all the right of patients in health care treatment. Questions continue to arise regarding the process of informed consent so the researchers chosen this study in order to know whether the persons right to selfdetermine was actually upheld. It does so by examining the development of indigenous peoples rights of participation, consultation, and consent in undergoing a specific medical intervention. The fundamental idea of this study is that patients should be able to

tailor the disclosure process to their own values and informational needs. The researchers aimed to study on the clinical practice of informed consent in UPHDMC are being done. Generally, the purpose of this study is to assess the extent of implementation of informed consent in UPHDMC. Review of Related Literature Foreign Literature CMS and informed consent: Is your institution getting it right? Bryant et.al (2008), stated hospitals must establish processes to assure that each patient or his/her representative is given information on the patient's health status, diagnosis, and prognosis. Hospitals must utilize an informed consent process that assures patients are given the information and disclosures needed to make an informed decision about whether to consent to a procedure, intervention, or type of care that requires consent. Informed decisions related to care planning also extend to discharge planning. Hospitals must establish policies and procedures that assure a patient's right to request or refuse treatment, and how this right will be exercised. Include the patient's right to delegate to a representative. Address the patient's right to have information on his medical status, diagnosis and prognosis and how patients will receive this information. How the patient will be involved in his/her care planning and treatment. The facility's informed consent policy should describe: Who may obtain the patient's informed consent. Which procedures require informed consent? The circumstances under which surgery is considered an emergency, and may be undertaken without informed consent. The circumstances when a patient's representative may give informed consent. The process

used to obtain informed consent, including how it is to be documented in the record. How the consent forms obtained outside the hospital will be incorporated in the patient's chart. Informed Consent Prior to Nursing Care Procedures Informed Consent is still an issue on the healthcare agenda. Consent is a process, not a form. It also continues to be a source of malpractice liability, because the legal requirements continue to lack complete clarity. And, done poorly, it contributes to a climate of public mistrust in healthcare professionals. Aveyard also stated that the principles of informed consent should underpin our approach to nursing care procedures, which should not be mechanistic but determined by the needs of individual patients. (Aveyard, 2008) Informed Consent

When nurses provide consent forms for clients to sign, nurses must ask the clients if they understand the procedure for which they are giving consent. If clients deny understanding or you suspect they do not understand, notify the physician, health care provider, or nursing supervisor. Health care providers must inform a client refusing surgery or other medical treatment about any harmful consequences of refusal. If the patient persists in refusing the treatment, this rejection needs to be written, signed and witnessed. It is important to note that nursing students cannot be and should be not be responsible for or asked to witness consent forms due to legal nature of documents. (Potter et.al, 2009)

Local Literature Hayt and Hayt stated that it is established principle of law that every human being of adult years and sound mind has right to determine what shall be done with his own body. He may choose whether to be treated or not and to what extent, no matter how necessary the medical care, or how imminent the danger to his life or health if he fails to submit to the treatment. The essential elements of informed consent include (1) the diagnosis and explanation of the condition; (2) a fair explanation of the procedures to be done and used and the consequences; (3) a description of alternative treatments or procedures; (4) a description of the benefits to be expected; (5) material rights if any; and (6) the prognosis, if the recommended care, procedure, is refused.

Informed Consent

According to Udan (2008) informed consent is an agreement by a client to accept a course of treatment or procedure after complete information, including the risks of treatment and facts relating to it, has been provided by the physician. The patient has the right to receive from his doctor information necessary to give informed consent prior to start of any procedure or treatment, the medically significant risks involved and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient has the right to know the name of the person responsible for the procedure or treatment.

Local Study

Applying a Sociolinguistic Model to the Analysis of Informed Consent Documents Molina et.al (2009) also stated that Informed consent is important because it promotes individual autonomy and offers security that patients will not be forced or misled into making decisions. It must therefore be designed to allow patients to have control over most of the information received and the chance to withdraw their own previous consent. Foreign Studies Evaluation of informed consent in health research: a questionnaire survey.

According to Lnsimies-Antikainen (2010) Informed consent is ethically and legally required for all biomedical and health research involving human participants. This study analyses the realization of informed consent in health research from the point of view of healthy, voluntary adult participants. Empirical studies from this point of view are still rare.

Factors associated with Quality of Informed Consent in Patients Admitted for Surgery: An Iranian Study.

According to Sheikhtaheri, (2010) Informed consent is regarded as a pillar of medical ethics. The purpose of this study was to evaluate perceptions of the informed consent process prior to surgery. Most of the participants (88.7%) reported that they had requested to be informed about the complications of the surgical procedures, including severe complications such as death, but most of them did not receive this information.

The most important factors associated with the perceived quality of informed consent were the patient's level of education and type of surgery. In conclusion, practices consistent with the principles of informed consent have not been adequately implemented in the surgical departments of these hospitals in Kashan. Injury Smith et.al, (2012) stated that Informed consent is vital to good surgical practice. This study aims to assess whether provision of written information improves trauma patients recall of the risks associated with their surgery. 121 consecutive trauma patients were randomised to receive structured verbal information or structured verbal information with the addition of supplementary written information at the time of obtaining consent for their surgery. Patients were followed up post-operatively (mean 3.2 days) with a questionnaire to assess recall of risks discussed during the consent interview and satisfaction with the consent process. Recall of risks discussed in the consent interview was found to be significantly improved in the group receiving written and verbal information compared to verbal information alone (mean questionnaire score 41% vs. 64%), p =0.0014 using the MannWhitney U test. Patient satisfaction with the consent process was improved in the group receiving written and verbal information and 90% of patients in both groups expressed a preference for both written and verbal information compared to verbal information alone. The changing face of informed surgical consent Moreover, Oosthuizen et.al, (2012) cited that the introduction of procedurespecific brochures improved patients' pre-operative knowledge. Although the failings of

current consenting practice are clear, the Request for Treatment consenting process would not appear to be a viable alternative because of the large number of patients unable to accurately recall the nature of the proposed surgery or potential complications, following consent counselling. ETHICS: Informed Consent: Revisiting the Issues According to Erlen, (2009), this article reports on a qualitative study examining the way in which nurses obtain such informed consent. Data were collected through focus group discussion and by using a critical incident technique in order to explore the way in which nurses approach consent prior to nursing care procedures. An analysis of the data provides evidence that consent was often not obtained by those who participated in the study and that refusals of care were often ignored. In addition, participants were often uncertain how to proceed with care when the patient was unable to consent. Consent is still an issue on the healthcare agenda. It appears we are still not doing it properly. Consent is a process, not a form. It also continues to be a source of malpractice liability, because the legal requirements continue to lack complete clarity. Synthesis The similarity of the study of the researchers from the related literature is that both agrees that inform consent process involves the following dimensions such as legality, ethical obligations, perception and extent of implementation. The differences however, the review of related literature emphasis is more on level of awareness, in terms of legality, ethical obligations and perception.

The researchers study focused on the Assessment of Informed Consent Process in UPHDMC: Basis for Program Development. Aside from demographic profile of the respondents, the researchers also included the following dimensions such as, legality, ethical obligations, perception and extent of implementation.

Theoretical framework

Faden and Beauchamp's 1986 work A History and Theory of Informed Consent is a primary source for informed consent theory within the legal and medical fields. It explores two foundations in moral theory for informed consent: one describing an autonomous authorization action by a subject, incorporating the concepts of understanding, no control (voluntariness), and intention; and the other, effective consent, decided within a set of rules in public policy, with such concepts as disclosure and competence. These general concepts of understanding, no control, disclosure, and competence have been, as we have seen, readily incorporated into the general ethical theory literature in medical and legal fields, and other related fields such as behavioral sciences. It serves as the basis for the examination of informed consent theory is grounded in the fact that almost all of the literature on informed consent in information technology refers back to Faden and Beauchamp for the theory used in developing informed consent practice. Faden and Beauchamp's theory of informed consent does not only form the basis for most of the literature in informed consent theory and practice, but the effective consent model is closest to that actually used in information technology procedures

10

Faden and Beauchamp begin by first exploring the idea of autonomy and how it underpins the idea of informed consent; they then discuss the main ethical concepts: intention, understanding, and no control. These concepts are tied together to form the autonomous action part of the authorization, and it is this act that constitutes their ``first sense'' of informed consent, that of informed consent as an autonomous authorization action (Flick, C. 2010).

Conceptual Framework

Input

Process

Output

Demographic profile a.) Age b.) Sex c.) Civil status d.) Socio economic status Informed consent dimensions a.) legality b.) ethical obligation c.) perception d.) extent of implementation

a) Data gathering b) Data processing such as encoding and data analysis.

Propose Informed Consent Enhancement Program.

FEEDBACK Figure 1

11

The research paradigm represents the variables that comprise the study about the Assessment Informed Consent Process in UPHDMC: Basis for Program Development. An input-process-output diagram includes all of the materials and information required for the process, details of the process itself, and descriptions of all products and byproducts resulting from the process. The input box contains demographic profile of the respondents gender, age, civil status, socio-economic status and the informed consent dimensions such as ethical obligations, legality and perception. While the process box contains the level of awareness and extent of implementation, data gathering and data processing such as encoding and data analysis includes frequency and weighted mean. And the last is the output box which contains the propose informed consent Development Program. Statement of the Problem: The study will assess the level of awareness of selected medical-surgical patients at UPHDMC, Las Pias on Informed Consent. Specifically, it aims to answer the following questions: 1. What is the demographic data of respondents in terms of: 1.1 Age; 1.2 Civil Status; 1.3 Educational Attainment 1.4 Gender; 1.5 Religion 1.6 Socio-economic status?

12

2. What is the level of awareness of the respondents about informed consent process in terms of: 2.1 Ethico-moral-legal aspect; 2.2 Extent of implementation? 3. Is there a significant difference on the extent of implementation of informed consent process in the respondents when they are grouped based on their demographic profile? 4. Based on the results of the study, what can be the proposed enhancement program? Hypothesis o There is no significant difference on the level of awareness of the respondents about informed consent process when they are grouped based on their demographic profile. Significance of the Study To the Patients at the University of Perpetual Help Dalta Medical Center (UPHDMC): They will be given the chance to improve their knowledge about the relevance of informed consent especially in their part as patients prior to nursing intervention to be done. To the Researchers: This study will enable the researchers to apply the theories learned in nursing research thus helping them to improve their knowledge and skills.

13

To the Nursing Students: They will be given more knowledge on the importance of Informed Consent to the Medical profession, the physician- nurse and especially the patient itself. They will be able to learn some alternative techniques or actions on how to emphasize the relevance and perform it as ethical issue is concerned. They will be competent and be effective nurses someday. To the Clinical Instructors: This study will give them knowledge and improve their learnings about Informed consent as they are in related to medical field. The clinical instructors then will be able justify and guide nursing students on their research. To the Future Researchers: This study will serve as guide and source of information to the future researchers thus make them finish their paper easier and faster. Scope and Limitation of the Study The respondents will be the forty five (45) selected Surgical Patients/ Guardian/ Parent who have signed the informed consent in University of Perpetual Help Dalta Medical Center (UPHDMC) they will be chosen by convenience and quota sampling. The researchers will conduct a study on First Semester of school year 2013-2014. The emphasis of the study is on the assessment of the extent of implementation of the informed consent process in UPHDMC: Basis for Program Development. .The actual study will be conducted on June to July 2013.

14

Definition of Terms The following terms are operationally defined for better understanding of the context in which the concepts are used in the study. Ethico-moral-legal aspect. Extent of implementation. Informed consent. Enhancement Program.

15

CHAPTER 2 METHODOLOGY This chapter presents the research design, population and sampling, participants of the study, the research instrument used and its description and validation, data gathering procedure and the statistical treatment utilized in analyzing and interpreting the data. Research Design The study used the descriptive method of research. Descriptive research refers to research studies that have as their main objective the accurate portrayal of the characteristics of person, situations or groups. This approach is used to describe variables rather than to test a predicted relationship between variables, since the study aims to determine the extent of implementation of informed consent in UPHDMC. Population Sampling The researchers will be utilizing the non-probability type of sampling specifically the Convenience Sampling and the Quota Sampling. Convenience Sampling is obtained when the researcher selects whatever sampling units are conveniently available. (Zulueta, 2010) Quota sampling on the other hand is the method wherein the researchers will be determining the sampling size which should be filled up. It may also be specified unto how many will be included according to some criteria such as surgical patients admitted at the surgical ward who signed the informed consent. (Zulueta, 2010)

16

Respondents of the Study The respondents will be the patients or guardians of the patients that will undergo surgical or laboratory test and who have signed the informed consent. The UPHDMC has one hundred fifty (150) working bed capacity. Using the 30% of the total population size the sample size of this study will be forty-five (45). The respondents will be chosen regardless of age, sex and educational level. Research Instruments The questionnaire method specifically the guidance response type will be used in collecting data. It was a self-made instrument developed out of reading and consulting sample questionnaires used on previous similar studies and from the review of related literature. The questionnaires have 4 parts and each part is composed of 7 questions. The first part is the Perception, the second part is the Implementation, the third part is the Ethics and the last part is the Legality. The questions will be answer by (5) strongly agree, (4) agree, (3) uncertain, (2) disagree and (1) strongly disagree by just putting a check part on the desired answer of the respondent. Validation of Research Instruments After drafting the questionnaire, it will be submitted to the experts such as surgeons and nurses for correction and approval. Specialists in the content will measure the instrument and are asked to judge the appropriateness of the items on the instrument. Do they cover the breath of the content area (does the instrument contains a representative sample of the content being assessed)? Are they in a format that is appropriate for those using the instrument?

17

The experts will be requested to rate each item in the questionnaire as to whether the items measured the variables under study. They will be ask if the questionnaire provides the respondent with an easy method of indicating his/her answer, if questions will be worded simply and clearly and if questionnaire is uncluttered and easy to complete and if the questionnaire helps directly achieve the research objectives. After they had filled them out, the researchers will retrieve the questionnaires and will note the feedbacks of the validators. Pilot of the Study After the retrieval of the questionnaire from the experts the researchers will make necessary revisions as suggested. A pilot study will be conducted at Jonelta Ward to test aspects of the research design and to allow the necessary adjustment before the final administration of the questionnaire. This will involve testing the feasibility in practice or improving the methodological quality of parts of the study. Data Gathering Procedure Interviews will be conducted one-on-one or with a small group (the smaller the better so that everyone has a chance to contribute fully). Interviews will be use throughout the data gathering process, but they are perhaps most useful during the performance analysis stage. Direct observation of work performance will be used in gathering data because it is done in conjunction with another data gathering method that is used to fill in the gaps and answer questions.

18

With the permission of Dean Ma. Imelda O. Javier, the Dean of the College of Nursing and Mrs. Amelia Mendoza RN MAN, the Nursing Head Officer of UPHDMC, the copies of the questionnaire will distributed personally by the researchers to the respondents. The respondents will be given adequate time to fill out the questionnaire. The questionnaires will be collected back from the respondents and will be carefully checked for completeness. Statistical Treatment The following statistical treatments will be using by the researchers to analyze the data and interpret the results: 1. To determine the demographic profile of the respondents in terms of Age; Gender; Civil Status; Socio-economic status; and Diagnosis will be treated with frequency and percentage in tabular distribution.

Frequency: Fi = =

Percentage: X 100% = %

19

2. The extent of the level of awareness of the respondents about Informed Consent Process in terms of Terms of Legality; Ethical Obligations; and Perception will be treated with weighted mean.

Mean: (n+n+n+n+n..) numbers of n = mean

Weighted mean: X= Value 5 4 3 Weighted Mean 4.51-5 3.51-4.5 2.51-3.5 Interpretation Fullest Implementation Full Implementation Moderate Implementation 2 1 1.51-2.5 1-1.5 Least Implementation No Implementation

Table 1 3. In order to reject or accept if there any significant difference on the extent of implementation of Inform Consent in the respondents when they are grouped base on their demographic profile, the researchers will be using the T-test, and analysis of variance (ANOVA).

20

a. Sum of squares components SSt = SSa + SSx1A SSA= n (.-..)2 SSna= (Yy - ) 2 b. Degree of Freedom Dfa= a-1, dfna= a(n-1) = N-a Dft = an-1 = n-1 c. Mean squares and F F=

21

REFERENCES

Books Potter, P. and Perry, A. (2009). Fundamentals of Nursing: 7th Edition (pg. 333). Publisher Mosley Elsevier (Elsevier, Inc.) Udan, J. (2009). Fundamentals of Nursing: Concept and Clinical Applications: 3rd Edition (pg. 468). Giuani Print House. Venzon, L. and Venzon, R. (2010). Professional Nursing in the Philippines: 11th Edition (pg. 175). C & E Publishing, Inc. Journals Aveyard, H. (2008). Informed Consent Prior to Nursing Care Procedures. American Society of Registered Nurses (ASRN.ORG) Beauchamp, Tom L., and James F. Childress. (2008). Principles of Biomedical Ethics. 6th ed. Oxford: Oxford University Press. Bisnar, P. (2008) History of Medical Malpractice in the Philippines (Part II.) Filipino Physician Blog. http://doktorko.com Bryant, S & Sagin, T. (2008). CMS and informed consent: Is your institution getting it right? American Society of Registered Nurses. De Castro, L. (2009). Failure of Informed Consent in Compensated Non-Related Kidney Donation in the Philippines. Asian Bioethics Review/June 2009 Volume 1, Issue2. http://muse.jhu.edu Edwards, K. (2008). Informed Consent. Ethics in Medicine of University of Washington School of Medicine, April 11, 2008 at http://depts.washington.edu/bioethx/topics/consent.html. Erlen, J. (2009). ETHICS: Informed Consent: Revisiting the Issues. Bio Info Bank Library. http://lib.bioinfo.pl/pmid:20664467. Flick, C. (2010). Informed Consent Theory. February 3, 2012 at www.liedra.net.

22

Hall, D., Prochazka, A., Fink, A. (2012) Informed Consent for Clinical Treatment. Canadian Medical Association Journal. Lnsimies-Antikainen, H. et.al. (2010). Evaluation of informed consent in health research: a questionnaire survey. Scandinavian Journal of Caring Sciences/ March 2010, Vol. 24 Issue 1. www.ebscohost.com. Molina, J. (2009). Applying a Sociolinguistic Model to the Analysis of Informed Consent Documents. Nursing Ethics. www.ebscohost.com Oosthuizen, JC et.al. (2012). The changing face of informed surgical consent. Journal of Laryngology & Otology/March 2012, Vol. 126 Issue 3. www.ebscohost.com. Pear, R. (2010). "Obama Returns to End-of-Life Plan That Caused Stir". December 25, 2010 at The New York Times. Sheikhtaheri, A. and Farzandipour, M. (2010). Factors associated with Quality of Informed Consent in Patients Admitted for Surgery: An Iranian Study. AJOB Primary Research; October 2010, Vol. 1 Issue 4. www.bioethics.net Smith, H. et.al, (2012). Injury. September 2012 at www.sciencedirect.com. Vol. 43 Issue 9, p1534-1538, 5p

23

APPENDIX A UNIVERSITY OF PERPETUAL HELP SYSTEM DALTA Alabang Zapote Road,Las Pinas City COLLEGE OF NURSING

Dear Respondents, We are the nursing students in the University of Perpetual Help System DALTA, Las Pias Campus, BSN 3A. We would like to seek your cooperation in accomplishing the questionnaire of our study Assessment of Informed Consent Process in UPHMC: Basis for Program Development. Please answer all questions honestly without leaving any items unanswered. Rest assured that your responses will be treated with utmost confidentiality. Thank you very much for your cooperation. The researchers: Angeles, Cathleen Joy Baltar, Michelle Carreon, Ma. Ericka Ednaco, Kenneth Jay Garcia, Patrick Angelo Palces, Ralph Andrew Rivera, Romalyn

24

I. Demographic Profile Direction: Please put a check mark on the boxes that correspond your answer. A. Age: Above 45 yrs. old 31 45 yrs. old B. Civil Status: Single Married 18 30 yrs. old Below 18 yrs. old

C. Diagnosis:________________________________________ D. Gender: Female Male

E. Socio-economic Status: Monthly Income Php 31,000 and above Php 16,000 30,000 II. Direction: The questionnaire contains questions that will assess the extent of implementation of informed consent process in UPHDMC. Kindly, put a check on the answer of your choice in the space provided. Value 5 4 3 Interpretation Fullest Implementation Full Implementation Moderate Implementation 2 1 Least Implementation No Implementation Php 15,000 and below

25

Implementation Strong Agree 5 1. The doctor/ staff spent enough time in explaining procedure. 2. They always asked me if I understand the procedure. 3. The staff used visual aids in explaining the procedure. 4. My doctor was always available to answer my questions 5. I was completely informed by the doctor of all the procedures, 4 3 2 Agree Uncertain Disagree Strongly Disagree 1

treatments, surgery obtain, etc. 6. I was very satisfied with the amount of involvement offered to my family with regards the

procedure 7. The doctor/ staff explained very well the informed consent and they give some alternatives/ options?

26

Ethics Strong Agree 5 1. I signed the informed consent voluntarily. 2. The physician- staff nurses give you enough time before deciding. 3. I think that the informed consent is ethically right? 4. The physicianstaff nurses 4 3 2 Agree Uncertain Disagree Strongly Disagree 1

obtained the inform consent in a right manner? 5. The physician- staff nurses give ample time for you to decide to sign for the inform consent? 6. I have no choice but to sign 7. The staff nurses hurt your feelings when she/ he explained/ gave to you about informed consent.

27

Legality Strong Agree 5 1. The inform consent form is 4 3 2 Agree Uncertain Disagree Strongly Disagree 1

specific for each procedure. 2. I was given a copy of the informed consent form. 3. I understand that the doctor/ staff nurses/ hospital administrators are not liable if the surgery fails prior to the expected outcome. 4. A legally authorized

representative can signed on behalf of an adult with diminished

decision- making capacity. 5. I consider that in a case to case basis aside from the scheduled surgery, another surgery be done as needed. 6. There is a significance of

guardian in the context of obtaining consent.

28

7. There is a basis why I need to sign in the informed consent.

29

Curriculum Vitae Name Address : : Cathleen Joy V. Angeles #37 Amelita St., BF HOMES, Almanza II, Las Pinas City Gender Date of Birth Place of Birth Civil Status Religion Father Mother : : : : : : : Female April 28, 1994 Las Pias City Single Roman Catholic Rolly A. Angeles Ma. Rosabel T. Villones

EDUCATIONAL BACKGROUND Elementary Secondary Tertiary : : : Almaza Elementary School Las Pias East National High School, Talon Village Annex University of Perpetual Help System DALTA

30

Curriculum Vitae Name Address : : Michelle Capate Baltar 179 P. Diego Cerra St. Las Pinas City Gender Date of Birth Place of Birth Civil Status Religion Father Mother : : : : : : : Female May 18, 1993 Brgy. Astorga Tunga, Leyte Single Roman Catholic Ubaldo Baltar Rosalinda Baltar

EDUCATIONAL BACKGROUND Elementary Secondary Tertiary : : : Astorga Elementary School Tunga, Leyte Gregorio C. Catenza National High School University of Perpetual Help System- DALTA

31

Curriculum Vitae Name Address : : Ma. Ericka Beatriz O. Carreon #4 Faith St, Veraville 1, Moonwalk Village, Las Pinas City Gender Date of Birth Place of Birth Civil Status Religion Father Mother : : : : : : : Female March 12, 1993 Manila Single Roman Catholic Enrique Carreon Sr. Ma. Vilma O. Carreon

EDUCATIONAL BACKGROUND Elementary Secondary Tertiary : : : Dona Mauela Elementary School RESPSCI University of Perpetual Help System DALTA

32

Curriculum Vitae Name Address : : Kenneth Jay I. Ednaco Blk 15 Lot 2 Faith St., Veraville 1, Moonwalk Village, Las Pinas City Gender Date of Birth Place of Birth Civil Status Religion Father Mother : : : : : : : Male August 23, 1993 Madonna Medical Hospital, Balayan, Batangas Single Roman Catholic Ernesto L. Ednaco Jr. Rodelina L. Ednaco

EDUCATIONAL BACKGROUND Elementary Secondary Tertiary : : : Lian Central School Lian Institute Batangas State University University of Perpetual Help System DALTA

33

Curriculum Vitae Name Address : : Patrick Angelo Q. Garcia 24 Skynet St. Moonwalk Village Talon V Las Pias City Gender Date of Birth Place of Birth Civil Status Religion Father Mother : : : : : : : Male August 13, 1993 Sampaloc, Manila Single Roman Catholic Maurice B. Garcia Nell Ann Q. Garcia

EDUCATIONAL BACKGROUND

Elementary

Mary Immaculate Parish Special School

Secondary

Mary Immaculate Parish Special School

Tertiary

University of Perpetual Help System DALTA

34

Curriculum Vitae Name Address : : Ralph Andrew B. Palces Courtyard II Portofino Heights, Daang-Hari, Muntinlupa City Gender Date of Birth Place of Birth Civil Status Religion Father Mother : : : : : : : Male June, 05, 1992 Quezon City Single Roman Catholic Raul B. Palces Ma. Theresa B. Palces

EDUCATIONAL BACKGROUND Elementary Secondary Tertiary : : : Elizabeth Seton School Legazpi Hope Christian School University of Perpetual Help System DALTA

35

Curriculum Vitae Name Address : : Romalyn C. Rivera 9021 km 23 West Service Road Alabang Muntinlupa City Gender Date of Birth Place of Birth Civil Status Religion Father Mother : : : : : : : Female June 30, 1987 La Medella Baao Camarines Sur Single Roman Catholic Rodrigo Rivera Marilyn Rivera

EDUCATIONAL BACKGROUND Elementary Secondary Tertiary : : : Masville Elementary School Dr. Arcadio Santos National High School University Of perpetual Help System DALTA

36

Theoretical Framework

Autonomous Authorization

A History and Theory of Informed Consent (Faden and Beauchamp's 1986 work)

Effective Consent

Understanding No control (voluntariness) Intention

Disclosure Competence