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Informed consent is the legal standard under which providers educate patients (those who have the capacity to make medical decisions or their surrogates) about proposed treatments and alternatives.1 The desirability of informed consent is based on the belief that it fosters the twin concepts of patient well-being and autonomy. Informed consent also provides a legal basis for autonomy.
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Providers should act in their patients' best interests while preserving autonomy whenever possible. The American College of Emergency Physicians Code of Ethics2 recognizes this dual obligation in stating that emergency physicians "serve the best interest of their patients by treating or preventing disease or injury and by informing patients about their condition." The code of ethics goes on to say, "Adult patients with decision-making capacity have a right to accept or refuse recommended health care, and physicians have a concomitant duty to respect their choices. This right is grounded in the moral principle of respect for patient autonomy and is expressed in the legal doctrine of informed consent."2
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BASIC ELEMENTS OF INFORMED CONSENT
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Most patients arriving at the ED sign a general consent for treatment. General consent for treatment is widely understood to cover history taking, standard examinations, and basic procedures such as venipuncture and blood analysis. General consent forms do not provide consent for more detailed, risky, or invasive procedures.
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Informed consent requires two conditions: the patient possesses decision-making capacity, and the patient can make a voluntary choice free of undue influence. The process of informed consent begins with the delivery of information to the patient by the provider. The patient must then reach a decision and authorize the procedure or treatment. Each part of the process is considered individually.
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Decision-making capacity (hereafter called "capacity") is the ability of the patient to make informed medical decisions. It is the provider's task to determine the patient's capacity.3 The definition of capacity varies among jurisdictions, but, in general, capacity describes an individual's ability to make a decision based on personal values and comprehension of the likely consequences of that decision.4,5
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One definition of capacity as it relates to health care is from Illinois law and reads: " 'Decisional capacity' means the ability to understand and appreciate the nature and consequences of a decision regarding medical treatment or forgoing life-sustaining treatment and the ability to reach and communicate an informed decision in the matter as determined by the attending physician."6 The American College of Physicians Ethics Manual describes decision-making capacity as "the ability to receive and express information and to make a choice consonant with that information and one's values."4
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Competence, which is often incorrectly used interchangeably with capacity, is a legal term indicating a ruling by a court that a person is able to ...