Contents

Search

informed consent/refusal

A legal doctrine that promotes shared decision making. It is a document signed by the patient or surrogate that provides evidence that a discussion took place. Elements necessary to provide informed consent: 1) a patient with the capacity to make decisions 2) adequate disclosure of all information (see disclosure) 3) comprehension of the information by the patient 4) an expression of a decision 5) assurance that the decision is voluntary, free from coercion , Components of informed consent are understanding of: 1) the recommended treatment 2) the benefits & risks of the recommended treatment 3) alternative treatments & their benefits & risks 4) what is likely to occur if no treatment is chosen Notes: - child & adolescent refusal of treatment [7] - informed refusal must be free from coercion - ethics committee can help evaluate coercion [2] - 'I don't like needles' by itself does not constitute an adequate explanation for informed refusal [5] - capable patients have the right to refuse recommended care - refusal of treatment is the beginning of a conversation - assess the patient's capacity to provide informed refusal - explore the patient's reasons for refusal - try to reach a compromise honoring patient values & providing standard of care [5]

Related

conflict of interest disclosure medical ethics

Specific

preoperative consent

General

FINDING

References

  1. Kapp M & Finucane T. Decision Making, In: Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw-Hill, New York, pg 590-91
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19. American College of Physicians, Philadelphia 2012, 2015, 2021
  3. Snyder L American College of Physicians Ethics Manual, Sixth Edition Annals of Internal Medicine 2012, 156(1):73-104 PMID: 22213573 http://www.annals.org/content/156/1_Part_2/73.full.pdf+html - Emanuel EJ Review of American College of Physicians Ethics Manual, Sixth Edition Annals of Internal Medicine 2012, 156(1):56-57 http://www.annals.org/content/156/1_Part_1/56.full.pdf+html
  4. Braddock CH 3rd, Edwards KA, Hasenberg NM et al Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999 Dec 22-29;282(24):2313-20. PMID: 10612318
  5. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  6. Meisel A, Kuczewski M. Legal and ethical myths about informed consent. Arch Intern Med. 1996 Dec 9-23;156(22):2521-6. Review. PMID: 8951294
  7. COMMITTEE ON BIOETHICS Informed Consent in Decision-Making in Pediatric Practice Pediatrics Jul 2016, e20161484 PMID: 27456514 - Katz AL, Webb SA; COMMITTEE ON BIOETHICS. Informed Consent in Decision-Making in Pediatric Practice. Pediatrics. 2016 Jul 25. pii: e20161485. PMID: 27456510
  8. Long KL, Ingraham AM, Wendt EM et al. Informed consent and informed decision-making in high-risk surgery: A quantitative analysis. J Am Coll Surg 2021 Sep; 233:337. PMID: 34102279 https://www.journalacs.org/article/S1072-7515(21)00414-2/fulltext
  9. Hall DE, Prochazka AV, Fink AS. Informed consent for clinical treatment. CMAJ 2012 184(5):533-540 PMID: 22392947 PMCID: PMC3307558 Free PMC article