Get Informed About “Informed Consent”
Lynn A. Fenton MD
Suppose your next patient for elective outpatient surgery, a 15-year-old boy, ASA I, for an open reduction, internal fixation (ORIF) of a mandible fracture is all alone in the preop area. You complete your perioperative checklist and discuss the Procedure, Alternatives, Risks, and give the patient the opportunity to ask Questions about the proposed anesthesia plan. You then notice that the Consent for Surgery/Anesthesia Form on the patient’s chart shows that only the patient signed the written consent form. Is this consent valid? Is it acceptable to continue with the anesthesia and surgery plans under these conditions? To answer these questions and others related to the topic of informed consent, learn and apply the mnemonic: “PTS.’ CONSENT & WE SMILE.”
P is for PARQ. These are the basic elements of medical informed consent. Keeping the patient’s perspective in mind, you should present and review the following with them: the nature and purpose of the Procedure/surgery or treatment, accepted Alternatives, potential benefits, and material Risks of the proposed treatment. Here, the anesthesiologist must disclose all information that a “reasonable person” would consider important in making a decision to undergo treatment. The patient may then ask Questions and, once satisfied, make a choice.
T is for TESTS TOO. Consent is also required for HIV tests, genetic tests, research studies, alternative treatments for breast cancer, and termination of pregnancy (TOP).
S is for SEVERAL FORM TYPES. There are three types of consent forms in common use: (i) the patient-signed consent form that the surgeon (or anesthesiologist if a separate anesthesia-specific consent form is available) is responsible for obtaining before surgery; (ii) the verbal agreement by the patient to the anesthesia care plan, usually part of the “Day of Surgery” section in most preoperative anesthesia evaluation forms; and (iii) a patient-signed consent form, which the anesthesiologist obtains for procedures performed by the anesthesiologist without a surgeon’s assistance (i.e., epidural blood patches, catheter or line placements, and pain management procedures). Some hospitals also have separate consent forms for blood transfusions (i.e., for Jehovah’s Witness patients).
C is for COMPETENCE, CAPACITY AND COMING OF AGE. Consent can be obtained only from a patient, legal guardian, or advocate
who is “competent.” Competency is a legal matter. It is a determination made by a court of law that an individual has the requisite abilities to make certain decisions such as those pertaining to medical care, daily aspects of life, personal finances, etc. It follows that a patient who has taken or been given mind-altering drugs (i.e., anxiolytics or narcotics) may not be able to give a valid consent. If a patient is deemed incompetent, social workers or psychiatrists may be consulted to further evaluate the individual’s competence and/or a guardian of person, or property, or both may be appointed for him or her. One common mistake in obtaining consent is to confuse competency with the capacity for decision making. Capacity for decision making, in contrast to competency, is a clinical determination. There are four recognized and legally validated components to decision-making capacity: understanding, appreciating, formulating or reasoning, and communicating a choice:
who is “competent.” Competency is a legal matter. It is a determination made by a court of law that an individual has the requisite abilities to make certain decisions such as those pertaining to medical care, daily aspects of life, personal finances, etc. It follows that a patient who has taken or been given mind-altering drugs (i.e., anxiolytics or narcotics) may not be able to give a valid consent. If a patient is deemed incompetent, social workers or psychiatrists may be consulted to further evaluate the individual’s competence and/or a guardian of person, or property, or both may be appointed for him or her. One common mistake in obtaining consent is to confuse competency with the capacity for decision making. Capacity for decision making, in contrast to competency, is a clinical determination. There are four recognized and legally validated components to decision-making capacity: understanding, appreciating, formulating or reasoning, and communicating a choice:
The patient must understand the known risks and benefits of the treatment and its alternatives.
The patient must be able to appreciate his or her clinical condition relative to the proposed treatment plan.
The patient must be able to formulate a plan for himself or herself, that is, have the intact ability to consider these factors appropriately in arriving at a reasonable decision.Related posts:
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