informed consent

[ageless]

I need info on the standards of practise for obtaining operative consent and/or informed consent. I am aware that state laws vary, so I need national standards backed up with sound references. This should include ultimate responsibility and accountability. Can someone direct me to a website or literature. ...Please be specific. Thanks in advance.

[KarafromPhilly]

Sjoe, that is so illegal! Raise this with your hospital's legal department, and CYA! That's a lawsuit waiting to happen!

[ageless]

I find that the legal questions come not from the lack of a signature, but the lack of informed consent. The informed consent is a process brought about by a conversation the physician has with the patient. The operative consent is the cummination of the process. In effect, informed consent has to be given before the patient gives signature. But this is the gray area. What truly constitutes being informed?

[KarafromPhilly]

Ageless, you're right. The states have had to figure out, one case at a time, what this might mean. Therefore, informed consent is a creation of what is known as "case" law, as opposed to statute. And since informed consent is not a federal issue, each state has its own standard. There very well may be national organizations that have taken a position on this issue and described what they think informed consent should mean, but these opinions do not have the force of law and therefore are not binding anywhere, although (state) courts might be moved to consider them when deciding an informed consent case.

[Agnus]

This is a tough one. I ask the patient if the physician has explained the procedure and ask if he understand the explanation he was given and if he has further questions.

I was taught that it is the person who will be doing the proceedure to inform the patient. (in some cases this is a nurse)

If it is a physician or another person I notify them the patient has more questions of them before they can sign. Sorry but the patient needs the answer from you.

I usually do not have to say this last line as they understand they have a responsibility and if the patient is not signing they will not be able to proceed. I do not say the patient refuses to sign unless that is the case. But I do advocate by saying they can't, until that person answers their questions. I don't try to answer myself as I am not a mind reader and may give wrong info. in this particular case.

[pebbles, BSN, RN]

Informes consent is either a very important concept or a joke, where I work - it depends on the doctor.

I had a patient once who got to the OR and tried to refuse surgery just before they were ready to start. Well, the docs spent two hour coercing her into the surgery. First time I ever saw a pt off the ward for four and a half hours for a lap choley.... Later, when I went to the chief resident to express my discomfort with this situation, he shrugged and said "well, she needed the surgery", looked at me like I was crazy for being concerned. This patient had tried to refuse because she was scared of being anaesthetized - had a history of being abused after being given drugs by a family member as a child. Our surgeons re-victimized this woman. I was so angry. But the other nurses just agreed with me quietly, but could do nothing - doctors have more power. We didn't have a manager at that time, or I'd have done something more.... I guess physician patronization of patients is alive and well, despite the "informed consent" laws.