informed consent/refusal

Introduction

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:

• a patient with the capacity to make decisions
• adequate disclosure of all information (see disclosure)
• comprehension of the information by the patient
• an expression of a decision
• assurance that the decision is voluntary, free from coercion ,

Components of informed consent are understanding of:

• the recommended treatment
• the benefits & risks of the recommended treatment
• alternative treatments & their benefits & risks
• what is likely to occur if no treatment is chosen

Notes

• child & adolescent refusal of treatment
• informed refusal must be free from coercion
  • ethics committee can help evaluate coercion
• 'I don't like needles' by itself does not constitute an adequate explanation for informed refusal
• 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

More specific terms

• preoperative consent

Additional terms

• conflict of interest
• disclosure
• medical ethics