PS26 2005: Consent for anaesthesia or sedation

 

List:

·         Summary

·         Voluntary

·         Competent

·         Informed

·         Gillick competence

 

Summary:

·         Must be voluntary

·         Must be competent

·         Must be informed

·         Must be documented

 

1.Must be voluntary:

·         No coercion

·         Ok to say no

·         Ok to change one’s mind

·         Ok to withdraw consent (e.g. multiple attempts at regional blockade)

·         Should have appropriate support if desired (spouse, relative, friend)

·         Should be at an appropriate time

·         Should be in an appropriate place

(i.e. alone + anaesthetic room + right before induction is a dreadful combination)

 

2.Must be competent:

·         General criteria:

o   Every individual presumed confident unless good evidence to the contrary

o   Not too young*

o   Not mentally incapacitated

o   Not unconscious

o   Not sedated

·         If incompetent and has a parent or guardian

o   Must act in the best interests of the patient

·         If incompetent and no parent or guardian and in a hurry

o   Must attempt to ascertain patient’s views

o   Must do what is in the patient’s best interests

o   Must do what we believe the patient would want

o   Should take into account the views of those close to the patient

o   Should obtain legal advice. Statutory body may provide consent or authorize somebody to do so.

·         If in a tearing hurry

o   Must provide information and allow discussion ASAP

 

2.Must be informed:

·         Principles:

o   Person performing the intervention is ultimately responsible

o   Person explaining must understand the intervention, pros, cons

o   Must provide a qualified interpreter if needed

o   Must provide information a reasonable patient would wish to know

o   Must provide information in a form the patient is likely to understand

o   Must allow for Q&A

o   N.B. cookie cutter documents are not sufficient

·         Content of information:

o   Basic information about the intervention (even if “I don’t want to know”)

o   Pros and cons of this treatment

o   Pros and cons of alternative treatments

o   Pros and cons of no treatment

o   Costs (if private)

·         Which risks to mention?

o   Common (e.g. sore throat, PONV)

o   Rare but bad (e.g. AMI, anaphylaxis, awareness, nerve damage, dental damage)

o   Blood products

o   Patient would want to know about it

o   Patient would likely consider it significant

o   Patient might change his/her mind on that basis

·         (All subjective! condition + intervention + attitude + understanding + questions)

 

Regarding borderline-too-young patients:

·         Varies depending upon the intervention

·         Varies depending upon the local law. If in doubt, ask.

·         Must be able to understand the nature of the intervention

·         Must be able to understand the purpose of the intervention

·         Must be able to understand the possible consequences of the intervention

 

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