MEDICAL CONSENT

CONSENT : Consent connotes agreement, compliance or permission given voluntarily without compulsion. The consent will be legally valid when it is given freely and voluntarily without any fear, favour, force or fraud after due understanding, what it is given for and of the risks involved. Section 90 IPC defines consent in negative terms that if the consent is obtained by coercion (under fear of injury) , undue influence , fraud , misrepresentation or misconception of fact , the consent gets vitiated(invalid) also consent given by a person who by unsoundness of mind, intoxication or immaturity of age(child< 12yrs of age) is incapable of understanding the nature and consequences of the act to which he consents is not valid in the eyes of the law

 Section 87 and 88 of IPC speak of exemption of liability when harm is caused by an act done in good faith and done for the benefit of the consenting individual. Sec 89 of IPC deals with cases where the act is done in good faith and for the benefit of the child or insane person by, or by consent of the guardian. Section 92 IPC deals with cases of emergency which are not covered by section 89 IPC .

Section 91, IPC: Consent given for committing a crime or illegal act [example: criminal abortion (induced abortion not indicated as per the Medical Termination of Pregnancy {MTP} Act] is invalid, irrespective of whether or not the act causes harm to the consenting party.

 Every human being of adult years and sound mind has a right to determine what shall be done with his own body and a surgeon who performs an operation without patients consent commits an assault for which he is liable in damages The above are the words of Judge Cardozo in 1914, expressed a patients right to autonomy in medical decision making. One who consents to being touched cannot later complain that he or she has been battered , even though the touching may have caused actual harm.

 KINDS OF CONSENT : EXPRESS CONSENT: The consent is express when the patients express his free consent either verbally or by writing . IMPLIED CONSENT: It can be imputed from the patients behavior and conduct. Implied consent will be inferred , when an adult patient of sound mind voluntarily (i) accepts the treatment, puts forth his arm to take the injection . (ii) cooperates with the physician , carries on his instructions, even though he has not given consent in words. (iii) calls a physician to his house, implying his consent for treatment. (iv) when an emergency operation has to be undertaken to save the patients life, its consent is implied.

 INFORMED CONSENT; It has now been recognized by all that the patient has the right of full information about his disease and future plan of treatment for it. Inform consent will signify the consent of the patient provided he has been fully informed about. 1) the nature of his ailments or disease process. 2) the nature and plan of proposed line of treatment. 3) the nature of risks involved in both the proposed or any alternative form or line of treatment. 4) the relative chances of success or failure in both the types of treatment.

Checklist - Informed Consent

name of operation nature of proposed treatment what the operation involves other treatment options or alternatives potential complications risks of operation risk of no treatment
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Checklist
special precautions required post-operatively benefits of treatment limitations of treatment success rate of operation what happens on admission how pt will feel after treatment

 LIMITATIONS OF FULL DISCLOSURES OF THE DOCTOR TO THE PATIENT: (a) when the patient is aware of or he indicates his preference not to be informed of. (b) Psychologically unstable , fear , apprehension prone, temperamentally neurotic patients should be informed about common known risks of the procedure of operation to be done , but not about likely or distant risks. THERAPEUTIC PRIVILEGE: being exception to full disclosure, the physician has the privilege to decide what to disclose what not. If he finds the patient emotionally disturbed, he may not disclose it to the detriment of patients health but he should write down his opinion in the patients case notes. He can disclose the risks to the next of kins of the patient.

 EXCEPTIONS IN EMERGENCY: The obligation to obtain informed consent before proceeding to treat a patient included in its statement an exception for emergencies . For there to be an emergency justifying treatment without informed consent , three conditions must be present. 1. the patient must be incapable of giving consent and no lawful surrogate is available to give the consent. 2. there is danger to life or danger of a serious impairment of health. 3. Immediate treatment is necessary to avert these dangers.

 TESTING AND INFORMED CONSENT : Tests can sometimes involve more than minimal risks , and even routine tests cost money and require time from the patient. The patient should be told the purpose of the test and the benefits, if any, to be gained by it, as well as the side effects and the risks. The variability of interpretation and the subjective component in decision making raise a question as to whether ethics demands that the patients be told the chance of testing errors. Eg:- the presence of exposure to AIDS is not detectable for a number of months after exposure, a negative test result may give an unjustified sense of security.