Authors: David E. Weissman, MD and Arthur Derse, MD, JD
In Fast Fact #164, the legal basis for the Informed Consent process was reviewed; this Fast Fact discusses common myths about Informed Consent that arise in palliative care; readers wishing more information should read the excellent review by Meisel and Kuczewski.
Myths
Use of Signed Consent Forms—Myth: Federal or state laws require written informed consent (patient signature) for invasive procedures. FALSE: The use of signed consent forms are used per local hospital or institutional or accrediting organization policies-they are generally not mandated by law or federal/state regulation. Note: state law may mandate written consent for certain tests or high risk treatment, (eg. HIV or genetic testing or electroconvulsive therapy) and federal law may require written consent in some circumstances (e.g. transfers from emergency departments). Signed consent forms may not shield the physician from claims of negligence due to failure to provide informed consent if the physician did not fulfill the Informed consent process (see FF #164).
Emergency Transport to a Medical Facility—Myth: No informed consent is necessary for patients admitted to a hospital in transfer from a nursing home, of for patients transported to the hospital following a 911 call. FALSE: There is no “implied consent” just because 911 or a transport ambulance was called, such patients require the same level of informed consent discussions for medical care decisions as any other patient, unless the medical situation satisfies the criteria for the emergency exception (see FF #164).
Low Risk Treatments—Myth:
No informed consent is necessary when starting “low
risk” life sustaining treatments such
as IV antibiotics, intravenous hydration,
G-Tube placement, or blood products.
FALSE: All these treatments
represent interventions with risks and alternatives.
An informed consent discussion is especially
necessary
in seriously ill or dying patients
where the option
of no intervention is a reasonable choice; the
failure to discuss not using life sustaining
intervention represents
a failure to provide
full informed
consent. Also, patients should be informed that
if a life sustaining treatment becomes too burdensome
(a
risk of any treatment), the patient
may withdraw
his or her consent and the treatment will be
withdrawn.
Present options but not a recommendation---Myth: Informed consent means that patients should choose among medical option without physicians introducing their bias toward one specific option. FALSE: The physician’s obligation is to present medical information accurately to the patient or to the individual responsible for the patient’s care and to make recommendations for management in accordance with good medical practice. The physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives.
Documentation--Myth: An informed consent discussion needs no special documentation except in cases of invasive procedures. FALSE: Even if not legally required, the content and outcome of an informed consent discussion should always be documented in the medical record and include the elements noted in FF #164 as an indication that the ethical and legal requirements of the process of informed consent have been fulfilled.
References
Meisel A and Kuczewski. Legal and ethical myths about Informed Consent. Arch Int Med 1996; 156:2521-2526.
Brett A and Rosenberg JC. The adequacy of informed consent for placement of gastrostomy tubes. Arch Intern Med 2001; 161:745-748.
American Medical Association: Informed Consent. http://www.ama-assn.org/ama/pub/category/4608.html
American Medical Association: Policy statement on provision of life-sustaining medical treatment. http://www.ama-assn.org/ama/pub/category/14899.html
Fast Facts were edited by David Weissman MD,
Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Weissman DE and Derse A. Fast Fact and Concept #164 Informed Consent in Palliative Care Part 2. October 2006. End-of-Life / Palliative Education Resource Center www.eperc.mcw.edu.
Disclaimer: Fast Facts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.
Purpose: Self-Study Guide, Teaching
Audience(s)
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Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice |
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Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery |
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Non-Physician: Nurses, Pharmacists/Clinical Pharmacists |
ACGME Competencies: Interpersonal Communication Skills; Professionalism
Keyword(s): Ethics, law, policy, health systems; communication