INFORMED MEDICAL CONSENT

INFORMED MEDICAL CONSENT

By law and medical ethics, doctors need informed consent to treat patients. The patient must be competent to make a voluntary choice.

A doctor determines if the patient is competent to make decisions, but the patient’s autonomy must always be respected. If the patient is incompetent, an informed consent is invalid.

In the hospital, a patient may make an impaired decision especially in neurological and infectious diseases. A study of over 300 inpatients showed 48% were incompetent to consent to medical treatment and ½ had mild to moderate dementia. Every patient may have some limitations in capacity with old age, little education, language problems, and cognitive impairment.

Currently unstructured judgments by doctors are standard. Yet their assessments greatly vary.

Legal standards for decision making for informed consent require:

1.Ability to communicate a choice
2. Understand the relevant information
3. Understand the medical consequences of a situation
4. Ability to reason about treatment choices.

How can a doctor protect you from the consequences of a bad choice and still respect you autonomy? Most people are capable of making their own decisions and very few are really incompetent.

As doctors see the seriousness of the consequences of the patient’s decision, they rate many patients incompetent. Older patients may not hear or see well and are on hospital medications that may make their mental comprehension temporarily fuzzy.

In an assessment one must be sure that:
1. The patient was given relevant information to make an informed decision about their treatment
2. Disclose the true nature of the patient’s condition and offer available alternative treatments
3. Be given the option of no treatment at all

If one is impaired, one should identify the source of the impairment and try to remedy the cause. Perhaps fever, dehydration, sedation, or lack of oxygen can make the patient temporarily impaired. Fear, anxiety, and lack of education can also interfere with making a competent judgment.

When an advanced directive is absent, and there is no immediate urgency, a family member must be contacted. Today there are no clear standards and guidelines to assess a patient’s capacity to consent to treatment. This is what makes lawyers happy and leads to increased confusion. Don’t let your rights be violated.

What do you think? Your comments always appreciated.
Source: NEJM 11.01.07
Visit us at www.drneedles.com for more informative blogs.