Patients Informed Consent

Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment. (Appelbaum, 2007)1 It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care. In order for the consent to be valid, the patient must be competent to take the particular decision; have received sufficient information to make a decision; and not be acting under stress.2,3

This may be an issue if consent is obtained upon the day of surgery. Most patients will have firmly decided to proceed for surgery. However,

Patients evaluated in acute pain will often have narcotics withheld until after the patient has been evaluated by a surgeon and has given informed consent. Concern that the patient would have impaired judgment due to narcotic effects often prevents the administration of timely pain relief. Similarly administration of anxiolytics and benzodiazepines are avoided until the patient has consented to the procedure.

As there is a considerable heterogeneity in the metabolism of a particular drug depending on age and patient characteristics, there is no specific timeline of how long should one wait prior to getting consent if these medications are given accidentally. This ends up in delays and possible cancellations of the procedure causing additional problems.

Informed consent is considered invalid if the patient has taken any sedative or anxiolytic. In case of pretreatment with opioids no difference in the judgment capacity was found using Hopkins Competency Assessment Tool (HCAT). This makes the validity of informed consent questionable with opioids.

There is a clear need for structured tools to evaluate capacity to consent. 2,3. A formal assessment of the decisional capacity for the surgical consent can be made by efficient screening methods with a questionnaire similar to MacArthur Competency Assessment Tool for Clinical