proposed modes for treatment
If Dr. Bob can get informed consent without jeopardizing the life of the patient then he should do so. If stopping to get consent will risk the life of the patient then he should consider the consent implied and save the life.
This would be called implied consent. It is contrasted with the legally required informed consent.
True, informed consent should be a process rather than a one-time event, since there are likely to be more than one aspect of a medical treatment about which a patient will need to be informed, and which will require consent.
Becky Cox White has written: 'Competence to consent' -- subject(s): Informed consent (Medical law), Capacity and disability, Medical ethics, Informed Consent, Patient Acceptance of Health Care, Mental Competency
the nature of the surgery; reasonable alternatives to the surgery; and the risks, benefits, and uncertainties of each option.
Expressed consent; The patient has the procedure explained to them, understands and agrees to it.Implied consent; The patient is unable to communicate their consent, but life-saving interventions are required. For instance, someone who has suffered a heart attack and is unconscious is legally offering implied consent for CPR to be performed on them.Third-party consent; The patient is mentally incapable of understanding the procedure and/or the ramifications of consent or refusal, so consent is given or withheld on their behalf by a legal designate, eg a parent or guardian in the case of children, or a power of attorney delegated by a person suffering a degenerative neural disease.
Informed consent can be either explicit or implicit; in either case, it is subject to judgement. Consider these examples: A dentist tells a patient that a tooth has to be extracted. By sitting in the chair and opening his mouth upon command, the patient, by implication, consents to the extraction. A physician tells a patient that the mole on her arm should be biopsied. By presenting her arm for the biopsy, the patient gives implied consent to the procedure. Is it necessary, in either of these cases, to obtain written consent which details all of the options, and the pros, cons, and costs of each? By obtaining written consent, are the dentist and physician absolved from liability? By being informed, can the patient be assured that all possible outcomes have been illuminated? What's the expression: "A grand jury can indict a ham sandwich." With or without informed consent, everyone is liable and no one is assured. As a rule, "routine," uncomplicated procedures are performed without first obtaining formal, written consent because, by implication, the patient consents by allowing the procedure to be performed. Usually, formal, written consent is sought in cases that involve considerable risk (death, e.g.) or unknown consequences (e.g., treatments whose outcomes are inconsistent). In the former instance, the patient's behavior is sufficient proof, formal evidence of disclosure being unnecessary; in the latter, it would, in the least, be prudent to obtain formal, written consent. Regardless of the situation, I dare say all practitioners, clinics, or hospitals appreciate the fact that proof of informed consent proves very little and is a meager barrier to litigation.
Did the patient demonstrably know: * What the treatment was for? (The ailment or condition). * What are the various phases of the treatment? * How long will the process take. * Risks * Changes as a result of the treatment, temporary and permanent. * Prognosis * Was the patient allowed to ask questions? * Did the patient acknowledge the above and still consent to the procedure?
This is a great question. Unless the form specifically allows for "partial DNR" then a full DNR includes DNI when the patient has cardiac or respiratory arrest. The question is more complicated when the patient is not a cardiac or respiratory arrest and the doctor wants to intubate. Then the question is really why isn't that doctor getting prior consent. A DNI presumes the right to act without consent (like CPR) In every other invasive treatment or procedure, informed consent is required beforehand so should it be with intubation (unless the patient is in cardiac/respiratory arrest). Doctors seem to use the "emergency exception" to the informed consent rule for emergency intubation (if we don't intubate the patient will go into respiratory arrest) But that may be inconsistent with the patients real spirit of the patient's DNR so in those circumstances, I think the doctor should really be getting the patient's next of kin (or medical POA) to consent or refuse consent (consistent with the DNR).
the "informed consent" should consist of : 1.) procedure to be performed 2.) location of performance of planned procedure 3.) signature of physician 4.) signature of patient 5.) signature of "witness" (this could be parent/guardian if pt. is a minor, or perhaps the doctor's assistant.....someone in room who witnesses the signatures being written) Just so you know, and this is what confuses ALOT of patients....the informed consent DOES NOT have to itemize any possible complications or side effects of the planned procedure!!!
Nathan Hershey has written: 'Informed consent study' -- subject(s): Consent (Law), Physician and patient 'Biology and the future of man' -- subject(s): History, Human ecology, Law and legislation, Medical genetics
Infection and bleeding occur rarely after skin biopsy. If the skin biopsy may leave a scar, the patient usually is asked to give informed consent before the test.