INFORMED 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 on informed consent. (Dec 2012)
->The essential components of professional negligence are three: -'duty', 'breach' and 'resulting damage'. ->Definition of Informed Consent:-Involves the communication of the anaesthetic plan in terms the patient understands and covers everything from preop procedure to intraoperative management and post procedural care. The alternatives, potential benefits are discussed and the patients questions are answered.

->Components 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.

->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

-to offer information to the extent that a reasonable person would consider it important for decision making.
C} SUBJECTIVE PERSON STANDARD

-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 anesthesiologists 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.

-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 patients 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***