Informed consent
More than a signature
Three key elements (Page 2 of 2)
3. Properly informing the patient
Canadian legal judgments dealing with informed consent suggest the following interpretations:- When possible inform the patient of the diagnosis. If some uncertainty exists about the diagnosis mention this uncertainty, the reason for it, and what other possibilities are being considered.
- Explain the proposed investigations or treatments.
- Indicate the chances of success.
- Inform the patient about available alternative treatments and their risks. There is no obligation to discuss what might be clearly regarded as unconventional therapy, but patients should know there are other accepted alternatives and why the recommended therapy has been chosen.
- Inform the patient about the consequences of leaving the medical condition untreated.
The courts have been quite clear that physicians are expected to answer patients' questions as honestly and completely as they can.
Material and special risks
- Material risks include risks that occur frequently as well as those that are very serious, such as death or permanent disability.
- A patient's special circumstances might require discussion of potential but normally uncommon risks of the investigation or treatment, when typically these might not be seen as material.
- The courts have been clear that the consent discussion extends to what the physician knows or should know a particular patient would deem relevant to making a decision about whether or not to undergo treatment.
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Case: A patient with an inflammatory bowel disease |
Background
Joan is a 57-year-old post-menopausal woman with a known diagnosis of osteoporosis.
Think about it
Before prescribing a course of steroids as treatment for Crohn's disease, what material and special risks might you wish to discuss with Joan?
Suggestions
You will want to discuss the possible common, but generally non- serious, side effects associated with corticosteroid therapy. As well, you will want to discuss the more serious, but fortunately less common potential side effects, such as the possibility of avascular necrosis of bone.Given Joan already has osteoporosis, you will also want to discuss the special risks of bone loss. Be sure to answer any questions Joan asks.
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Case: A violinist with hand symptoms |
Background
A plastic surgeon is discussing a carpal tunnel release in a 59-year-old violinist.
Think about it
What risks should be included in the consent discussion?