To obtain a legally effective informed consent from a patient for a procedure the patient ought to be told in terms that he understands:
- Procedure or Treatment
- Risks and Consequences
- Feasible Treatment Alternative
- No Treatment Outcome
The difference between ‘risk’ and ‘consequences’ is significant. A risk is something that might happen, such as an infection. A consequence is something that will happen.
Informed Consent is not a form. A form signed by the patient may serve as evidence that his consent to the procedure was obtained, but valid informed consent is a process in which the physician makes sure the patient under stands the material facts he needs to make a sound decision whether or not to accept the procedure. It is more than prudent to chart informed consent rather than rely solely on an office form. If a patient is reluctant to sign a form but consents to the procedure then charting informed consent should be adequate.
Do not use ‘Informed Consent’ when a patient insists on alternative medicine. Use ‘Assumption of Risk’ as discussed in a later post.
- Unconscious or Incapacitated Patient
- Patient Waiver
If a patient must give his consent to a medical procedure before it can be performed, it follows that a patient who is a competent adult also has the right to refuse treatment. Doing an invasive procedure that a competent adult has refused is a battery, a tort for which the physician can be sued and which may not be covered by his malpractice policy.
The Supreme Court case of Cruzan held, among other things, that a competent adult has the right to refuse medical treatment including artificial nutrition and hydration.