Monday Med Mania

What is Informed Consent?

I have actually consulted on several medical cases that related to the issue of informed consent. What patients as well as physicians need to realize is that consent is much more than just a patient's signature on a authorization form. It is actually a legally binding contract between the patient and the physician. In order for consent to be provided three seperate and distinct elements must be validated:

• The patient must be competent and able to provide consent of their own free-will.
• The patient must have an understanding of what they have agreed to.
• The patient must have enough information on which to base a decision.

When I first became a nurse many years ago we were expected to give the patient all the required information and have them simply sign the consent. Those days are no more. Physicians who continue to practice in this manner are asking for serious liability issues. It is the physician's sole responsibility to inform the patient of the risks, benefits and alternatives associated with the specific procedure or treatment. Any failure to disclose a small piece of that information by the physician can render consent as invalid.

The most recent case I worked on involved a situation where the physician failed to mention to the patient that the procedure was actually contraindicated under the circumstances. The consequences were devastating for the patient and family. The physician thought he was covered by documenting the patient's understanding of the risks involved with the procedure. However, the physician's failure to disclose that the procedure was contraindicated rendered the patient's consent invalid. In this case there was not enough information for the patient to base a decision.

Physicians need to understand that selective inclusion of information does not qualify as adequate information for informing the patient of risks, benefits and alternatives. The prevailing standard of care is that a physician must inform the patient of whatever a reasonable physician would inform the patient under the same or similar circumstances. In some cases this may require expert testimony from expert physicians to determine what a reasonable physician would do.

However, some states are now forgoing expert testimony in favor of new standards which require a physician to provide whatever information is needed for the average patient to make an informed decision. Whatever the case, patients need to be given the facts and not an opinion. Informed consent should allow patients to participate in their own healthcare decisions and not manipulated into them.