II. Definitions
- Informed Consent
- Patient willingly participates in medical therapy
- Requires understanding what is involved with the proposed therapy
- Personal Autonomy
- Given capacity, patients may make medical decisions for themselves
- Patients are given adequate information about their condition and treatment options to make an informed decision
- Beneficence
- Medical care given provides more benefit than harm
- Nonmaleficence
- Avoiding both intentional and unintentional harm to patients
- Social Justice
- Medical professional duty to promote fair health care resource allocation and delivery
III. Protocol: Requirements for valid Informed Consent
- Informed Consent should be obtained by the provider performing the procedure
- Patient (or their proxy) must have Medical Decision-Making Capacity
- See Medical Decision-Making Capacity
- See CURVES Mnemonic for Capacity Assessment
- Communicates choices
- Understands relevant information
- Reasons with logical, rational choices
- Values of patients are consistent with their choices
- Patient must be given sufficient information including treatment risks and benefits
- Patient makes decision without coercion and with adequate information about alternatives to proposed procedure
- Decision must be stable over time with the patient likely to consistently make the same decision if asked a second time
IV. Protocol: Criteria for treating a patient without Informed Consent (all must be present)
- Patient does not have adequate Decision-Making Capacity (e.g. unconscious or Delirium) AND
- No surrogate decision maker or legal document is available AND
- Situation is true emergency with threat to life or limb
V. Protocol: Approach to documentation
- See Medical Documentation
- Obtain written Informed Consent for procedures including contingency plans and document that consent was obtained
- Document patient refusal of recommended important clinical interventions in high risk conditions
- Obtain signature for refusal Against Medical Advice
VI. References
- Seeyave, Sherman and Ward (2020) Crit Dec Emerg Med 34(1): 19-25
- Weinstock and Henry in Herbert (2018) EM:Rap 18(1): 19-21
- Bradford-Saffles and Arambasick (2013) Crit Dec Emerg Med 27(6): 11-5
- Henry (2013) Avoid Being Sued, EM Bootcamp, CEME