Informed Consent
The Patient Care Partnership establishes the patient’s right to make decisions regarding his or her health care. The doctrine of informed consent refers to full disclosure of the facts the patient needs to make an intelligent (informed) decision before any invasive treatment or procedure is performed (Figure 2-3). The patient has the right to accept or reject the proposed care but only after understanding fully what is being proposed—that is, the benefits of the treatment, the risks involved, any alternative treatments, and the consequences
of refusing the treatment or procedure. The explanation of the procedure has to be in nontechnical terms and in a language the patient can understand. Failure to secure informed consent may result in civil liability for battery. Civil battery (also called technical battery) is the unlawful touching of a person; an intent to harm is not necessary. Consent must be freely given. Coercion negates the spirit of informed consent. Patients who seek treatment sign forms to indicate acceptance of care interventions. Additional consent for treatment may be needed for further invasive actions. Patients may withdraw or limit consent at any time. Consent may be communicated in a variety of ways. Patients may imply consent by their actions. Patients may verbalize their acceptance of treatment interventions. Invasive procedures may require a written consent document to be completed.
Consent must be provided by the appropriate perÂson (Benak and Applegate, 2006). To provide consent, the patient must be at least 18 years of age. Minors under the age of 18 years may consent for treatment in the event they meet certain criteria including the following:
- Marriage
- Court-approved emancipation
- Living apart from parents or guardians for at least 60 days and independent of parental support
- Service in the armed forces
In some situations, a minor may consent for care, including treatment for sexually transmitted infections, drug and alcohol abuse, sexual assault, and family planning.
There must also be competence to consent for care. Competence requires that the patient be of sound mind to accept the treatment. In addition, consent cannot be obtained from one who is impaired or under the inÂfluence of alcohol or drugs. In the event the patient is deemed incompetent to provide consent, a legal process exists for the determination of the individual legally eligible to provide the consent. In many cases, consent is provided by the spouse. In the absence of the spouse, this role may be passed to another legally identified individual.
It is the duty of the physician or nurse practitioner who is performing the procedure or treatment to provide the needed information to the patient. The nurse often has the responsibility to witness the patient signing the consent. In this case, the nurse’s responsibility is limited to the actual witnessing of the signature, not provision of information. The nurse does not discuss with the patient the elements of disclosure that the physician or the nurse practitioner are required to make. Involvement in providing this type of information to the patient potentially places the nurse in a position of liability. Answers to any unanswered questions that the patient has about the procedure are the responsibility of the health care provider who will perform the procedure.
Certain situations may require consent for treatment to be obtained over the telephone. Health care facilities have policies that govern telephonic consent. This type of consent is traditionally needed in management of emergency procedures.