Informed Consent and the Surgical Procedure

The process of consent should apply not only to surgical procedures but all clinical procedures and examinations which involve any form of touching. This must not mean more forms: it means more communication. As part of the process of obtaining consent, except when they have indicated otherwise, patients should be given sufficient information about what is to take place, the risks, uncertainties, and possible negative consequences of the proposed treatment, about any alternatives and about the likely outcome, to enable them to make a choice about how to proceed.”5

According to the Oxford Dictionary consent is defined as ‘giving permission for something to happen or agreeing to do something’. They define confidentiality as ‘entrusted with private information and if something is intended to be kept secret or in confidence’ (Soanes and Hawker, 2005). As a healthcare professional consent and confidentiality are in place as protective vices, by gaining consent and keeping a patients confidentiality it protects both the patient and the healthcare professional. There are three types of consent: Verbal consent, consent in writing and implied consent. Depending on the situation each type of consent may not be acceptable. For example if a procedure is putting a patient at risk, is complex or invasive for example an operation, written consent is

Informed consent is the basis for all legal and moral aspects of a patient’s autonomy. Implied consent is when you and your physician interact in which the consent is assumed, such as in a physical exam by your doctor. Written consent is a more extensive form in which it mostly applies when there is testing or experiments involved over a period of time. The long process is making sure the patient properly understands the risk and benefits that could possible happen during and after the treatment. As a physician, he must respect the patient’s autonomy. For a patient to be an autonomous agent, he must have legitimate moral values. The patient has all the rights to his medical health and conditions that arise. When considering informed

This information must be easy for the patient to understand and must also be correct and truthful (RCN 2013). The Department of Health define consent as allowing a capable individual to make their own decisions about their health care without being pressured into making any decisions from others such as friends, family and health care professionals. In the adult nursing field it is legal and ethical to gain valid consent before starting a medical procedure, or providing care. This shows that the individuals rights have been respected which is good practice. If a healthcare professional did not respect an individual’s choices they could be accountable to legal proceedings. In common law touching or performing an act of care on a patient without valid consent can be classed as a criminal offence or battery. If a healthcare professional was not following the legal practice regarding consent then the individual may be faced with a criminal offence and disciplinary action will take place (Dimond 2009). The Human Rights Act states that all healthcare professionals should never judge an individual on their sex, race, religion, social origin, language or any other status.

The Doctor and Patient relationship aspect of Medicine has changed drastically in the last twenty years. It has evolved from paternalism (the doctor makes the decision for the patient) to shared decision making where the patient is considered an equal partner in his/her own health related decisions. Informed consent is the cornerstone for this view. When a patient or a research subject makes an autonomous decision after understanding, the risks and benefits involved with the decision is Informed consent. Complete Informed consent covers the following components: competency, disclosure, comprehension and voluntary. Competency refers to the requirement for the individual to be of legal age and be mentally competent to understand the process.

Patient informed consent refers to the situation where the patient is fully informed on the consequences of their health care decision after which the patient gives the decision. For there to be informed consent, there are five elements that must be discussed. The first is the nature of the patient's decision then the applicable alternatives to the proposed intervention. Third are the risks, benefits and uncertainties associated with each of the alternatives. Fourth is the assessment of the patient's understanding and last is the acceptance of the intervention or an alternative by the patient. Before the patient's consent is considered to be valid, the patient's competency to make the decision must be addressed. The criteria for evaluating the patient's competency is clearly stated in section 3 of the 2005 Mental Capacity Act which states that provided the person is able to understand, retain and use information provided and to communicate their decision in any way such as talking or sign language, they are competent to make a decision. If a patient is treated against their refusal to consent, it amounts to the tort of battery or can also be considered the crime of assault. In addition to this, laws that touch on human rights reinforce the importance of the protection of the physical integrity of the individual in terms of their right to respect of their private life. Therefore, refusal of medical treatment is a human right.

. The most important goal of informed consent is that the patient has an opportunity to be an informed participant in her

Every patient has a right to decide on their own course of treatment and freely consent to that treatment. In order to make an educated decision they must be provided with the proper information to make an informed choice (Opinion 8.08 - Informed Consent, 2006). It is the physician’s legal and ethical obligation to provide this information when making their recommendation on treatment. The choices given must be in accordance with good medical practice (Opinion 8.08 - Informed Consent, 2006). The informed consent is the legal policy, either written or verbal, that gives full disclosure of all the information including potential risks that is applicable to the patient’s condition and treatment being offered (Kazmier, 2008).

The author cites qualitative research articles and nursing education manuals and training manuals from many different authors and time periods. There were no quantitative studies cited. All research article referenced were relevant to the study, most were greater than seven years old and older. No evaluations of strengths or weaknesses were available for referenced material. The limitations of this study were named as: “data was exploratory, It was not the specific intention to explore the management of the patient who refuses care; the topic came from the inductive data analysis.(Aveyard, 2004, p. 349) It is relevant as this is a previously unexplored area of nursing.(Aveyard, 2004, p. 349) The author builds a logical argument through discussion of nursing education, and the fact that nursing education and the focus of informed consent in nursing education is on the nurse’s role in obtaining consent prior to medical procedures and research procedures, and not prior to nursing care procedures. The author uses the argument that the lack of discussion on informed consent does not negate its importance and it purpose which is to protect a patients autonomy .(Aveyard, 2004, p. 346)

Obtaining an informed consent is a vital part of current health care. This document lists out several key pieces of information for both the patient, Provider, and the ancillary staff that also access the document during the procedure process. However, obtaining informed consent has not always been the practice norm and in research, informed consent carries different specifications.

Similarly, Canadian Nurses Association, (2009), further emphasizes the value of informed consent by promoting and respecting informed decision making. It is one of the ethical responsibilities of Canadian registered nurses. Nurses can play a vital role on behalf of their clients in obtaining informed consent process as a resource person, a co-ordinator or a facilitator to support their client to make an informed decision making. (CNA,

When a patient needs to have a medical procedure performed, they must first consent to the procedure. Before accepting or rejecting the treatment, the practitioner is required to give the patient information pertaining to the risks and benefits of the procedure, as well as available alternatives. Additionally, the patient must be mentally competent enough to make an informed decision, and not be manipulated or coerced into a decision.

Informed consent is supposed to show that the patient has been informed of the possible risks or consequences, typically for treatment they are agreeing to receive from a doctor. A person might be faced with giving informed consent in research settings, specialized treatments, and/or routine appointments with any health care provider. In the medical field physicians must obtain informed consent from every patient/patient representative in order to treat the patient without leaving themselves open to a lawsuit for negligence.

Informed consent is a document that the patient must sign which allows the process of the treatment to be begin. The paper must be sign to protect the patient as well as the doctor from any legal issues. Before the heath care professional can perform treatment(s), the patient must be informed of all possible dangers and possible side effects. The basic principles that are in an informed consent document include the followings. The patient must have a clear understanding about the situation.

At a practice level, the importance and guidance of the Code of Conduct, Code of Ethics and NPA are demonstrated on a daily basis with regard to the issues of documentation, informed consent and open disclosure, and confidentiality. With respect to documentation, nurses must be able to document patient assessments and responses in an accurate, comprehensive and confidential manner and record all observations objectively. Informed consent and open disclosure are also major legal issues nurses face daily. It refers to the communication between the patient and health professional that results in the patient's agreement to undergo a specific procedure and requires that the patient has thoroughly understood the procedure, implications and risks prior to giving written consent.