INFORMED CONSENT IN SURGERY.pptx

This slideshare is about informed consent generally, using surgical practice as a case study.

1. INFORMED CONSENT IN SURGERY DR. IZEVBEKHAI FELIX U.

2. OUTLINE Introduction General principles Types of consent Process of obtaining informed consent Consent in children, unconscious patient and mentally ill Consent in Jehovah’s Witnesses Special consideration Consent form Conclusion

3. INTRODUCTION Consent simply means agreement/permission Informed consent is the process in which a healthcare provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. The patient must be competent to make a voluntary decision whether to undergo the procedure or interventon .

4. Both an ethical and legal obligation of medical practitioners and originates from the patient’s right to direct what happens to their body. Implicit in providing informed consent is an assessment of the patient’s understanding, rendering an actual recommendation, and documentation of the process.

5. Requirements Of Informed Consent Subject must be competent to understand and decide Subject has received full disclosure Subject comprehends the disclosure Subject acts voluntarily Subject consents to the proposed action

6. GENERAL PRINCIPLES Obtained prior to a procedure Sedation free Obtained by a qualified clinician Not under coercion No alteration should be made Should not exceed authority given In emergency, clinicians may undertake any procedure to save life In elective procedures, ample time is needed

7. TYPES OF CONSENT Implied consent Expressed consent

8. Implied Consent: verbal agreement to undergo procedure with no associated risk eg physical examination. Expressed Consent: can be oral or written, the latter is more genuine. In minor procedures, verbal consent is sufficient. In major procedures, written consent must be obtained

9. OBTAINING INFORMED CONSENT Clinician should introduce himself to the patient Assess the patient’s level of understanding of the procedure/ pathology Explain to the patient freely Re-emphasize the diagnosis and the natural history of the disease with and without treatment Give treatment options and types of anaesthesia Explain the purpose of a proposed investigation or treatment Describe the likely benefits and probability of success, cost, and long-term follow-up if needed

10. Describe any possible adverse effects; fertility, potency, continence, etc Explain procedures using diagrams and patient information sheets Information given is influenced by patient’s understanding, educational, social background and translation if necessary The help of another healthcare professional may be needed

11. Ask patients if they have understood and give room for questions Answer questions honestly Make sure patient reads consent and signs it Clinician should sign the form, print his name and date.

12. SURGICAL BIOETHICS AND CONSENT Ethics is an accepted way of doing things. Surgical bioethics are Principles of bioethics Autonomy Beneficience Nonmaleficience Justice

13. Autonomy- all persons have intrinsic and unconditional worth. Each person has a right to self determination and reserve the power to make moral choices. Informed consent Truth telling Confidentiality Exceptions to autonomy Children except emancipated minors Persons with developmental, physical or mental incompetence.

14. Decision makers Above 18 years Waived consent Emancipated minor Legal surrogate

15. CONSENT IN CHILDREN Under 18yrs of age Cannot provide informed consent Written consent is required from the parent/guardian Not termed ‘informed consent’ but ‘informed permission’ If surgeon believes proxy’s decision not in child’s best interest, child can be made a ward of court and appropriately treated Exceptionally, adolescents(14-16yrs) consent adequately if sufficiently mature

16. Exception to this rule is a legally emancipated child who may provide informed consent for himself Examples of emancipated minor: Under 18 and married Serving in the military Able to prove financial independence Mothers of children(married or not) All subject to the laws of the state, however

17. CONSENT IN UNCONSCIOUS PATIENTS Surgeon may treat if procedure is life-saving Consent of relative/friend not required No legal proxy for adult

18. MENTALLY ILL/HANDICAPPED Not competent to consent If detained under mental health act, only procedures to preserve life can be performed Surgeons and psychiatrists must agree that treatment is in patient’s best interest No one can give or withhold consent on behalf of mentally incapacitated patient If patient is unwilling to have treatment, then it should not be performed Mentally ill patients have same rights as other patients

19. CONSENT IN JEHOVAH’S WITNESSES In emergency life threatening situation, the surgeon will have to proceed with an acceptable alternative In elective situation, the surgeon has the right to refuse to treat Patient must be fully counselled as to the possible dangers of their action and must sign a specially prepared consent form noting all these All discussion must be clearly documented in the notes

20. After discussion with the patient, the management plan must be communicated to all staffs responsible for the patient

21. SPECIAL CONSIDERATION In procedures that involve sensitive body function, eg amputations, colostomies, prostatectomies , etc Consent must not be from a third party Ample time should be given to a patient to make decisions Consent must be signed more than once and at different occasions Pictures and video taping Confidentiality all through

22. CONSENT FORM Should contain the following items: Name of the hospital Patient’s name, address and signature Hospital number Name of the procedure Surgeon’s name and signiture Anaesthetist’s name and signature Name and signature of the relative as witness Date and time of taking the consent

23. CONCLUSION Consent is a legal tool for the surgeon It should not be neglected Thoroughness is of essense and should be a continuous process pre-, per-, and post-operatively

24. References Slim K, Bazin JE. From informed consent to shared decision-making in surgery. J Visc Surg. 2019 Jun;156(3).181-184 Shah P, Thornton I, Turrin D, et al. Informed consent. [Updated 2022 June 11] Bashir Bin Yunus . Compendium for surgery tutorials.

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