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I NF ORM ED CONSENT

1. Informed consent (Dec 2000) (June 2010).

2. Describe consent in anaesthesia practice including ethical and legal aspects

(Dec 2010)3. What are the ingredients of professional negligence? Write a note oninformed consent. (Dec 2012 )

->The essential components of professional negligence are three: -'duty', 'breach' and 'resulting

damage' .

->De finition of Informed Consent:-Involves the communication of the anaesthetic plan in terms

the patient understands and covers everything from preop procedure to intraoperativemanagement and post procedural care. The alternatives, potential benefits are discussed and

the patients questions are answered.

->Componen ts of Informed Consent :-

i) Decision making capacity

ii) Voluntariness

iii) Disclosure

a} Bolam Principle or Professional Practice Standard

b} Reasonable Person Standard or the Prudent Person Test

c} Subjective Person Standard

iv) Comprehension

v) Decision

i) Decision Making Capacity

->Anesthesiologists should permit patients to make decisions to the extent of their capacity.

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->Decision making capacity includes:-

A} ability to understand the situation

B} to comprehend the relevant information

C} to have a rational, internally consistent reasoning

D} to express a preference

->In life threatening situations, the anesthesiologists should proceed after obtaining informed

consent from the legal guardian or an authorized representative.

->Assistance from colleagues should be sought whenever besieged by clinical dilemmas.

ii) Voluntariness

-cardinal principle of the informed consent process.

-anesthesiologist should perform procedure, only on competent persons, who after considering

the information; have arrived at a voluntary decision without coercion/undue

influence/inducement.

iii) Disclosure

-Goal of disclosure is to provide adequate and relevant information to the patient that enables

one to arrive at an accurate and voluntary decision.

-There are various approaches:-

A} PROFESSIONAL PRACTICE STANDARD OR THE BOLAM PRINCIPLE

-to provide disclosure to the level dictated by the practices of the local physician community

-Drawback:-patient is not at the center of the decision making

B} REASONABLE PERSON STANDARD OR THE PRUDENT PERSON TEST

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-to offer information to the extent that a reasonable person would consider it important for

decision making.

C} SUBJECTIVE PERSON STA NDARD

-ideal option, wherein the anesthesiologist should tailor the disclosure process to the particular

patients desire.

iv) Comprehension

-Patients need to fully understand the risks and benefits of the proposed procedures and the

basis of the recommendations made.

v) Decision

-After considering the information and the anesthesio logists recommendations, the patient may

choose/refuse an anaesthetic technique.

ISSUES IN INFORMED CONSENT

1)Emergency Situations:- The refusal of life sustaining treatment must be clear, either on the

basis of a refusal by a patient with decision making capacity or on proof a clear, valid advanced

directive .The requirements to obtain informed consent are overridden by the exigencies of

emergency care.

2) Jehovahs Witness :-Refuse to accept blood transfusion, even to save their lives.

-Periop blood conservation strategies are then employed which include

Deliberate hypotension/blood substitutes/erythropoietin

3) Paediatric informed consent:- The concepts of best interests, informed assent and informed

permission are used by parents, other surrogate decision makers, patient s and physicians to

guide decision making for minors.

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-When the child becomes older, informed assent should be integrated in the informed consent

process.

-Paediatric patients can and should share decision making to the extent that their development

permits.

4) Refusing to provide care: - Anesthesiologists may refuse to provide care when they disagree

for ethical and moral reasons with the proposed procedure or believe that the p atients choice is

inappropriate or likely to result in harm.

5) Confidentiality:- to protect the rights and privacy of the patients

****-inadvertent comments, public discussions, personal remarks at bedside or in electronic

/medical/financial records should be withheld***