Consent in medical practice

 

Consent:

Section 13 of Indian Contract Act defines that two or more persons are said to consent when they agree upon the same thing in the same sense.

Types

According to the information provided to the patient by the doctor

1. Informed

2. Uninformed

Uninformed consent is illegal unless it falls within the concept of therapeutic privilege.

Informed consent means consent for any procedure or treatment after fully informing about his condition.

Components of informed consent:

Disclosure: Full disclosure of information which is material to a decision.

Comprehension: Complete understanding of information disclosed

Absence of outside control

Competence: The person should be competent to give consent

Actual consent: It should be in writing with signature of the patient and two independent witnesses.

According to the patient communicates to the doctor

1. Implied.

2. Express (i) Oral, (ii) Written

Implied consent: This type of consent is specifically stated by the patient and is seen in routine medical practice and is quite adequate. In these situations, consent is implied in the sense that patient has come to physician with a physical condition or ailment for examination and treatment. When a patient holds out his arm for an injection it is implied consent. If the procedure is simple and the risk is negligible implied consent is enough but if there is the slightest fear of complication, the doctor should seek express consent.

Express consent: May be written or verbal, and should be obtained for any procedure beyond the routine physical examination, like operation, blood transfusion etc. The nature and consequences of the procedure should be explained before obtaining consent.

In informed consent, the doctor informs the patient about his/her condition or disease, nature of the proposed treatment, availability of any alternative procedure, the possible risks and benefits of the procedure and the percentage of chances of success and failure.

The patient should be explained in a simple language that he can understand fully and give consent in the presence of third party who acts as a witness. Once the consent is obtained any untoward reaction or harm cause to the patient cannot lead to charge of negligence for the doctor.

Blanket consent: Consent taken for any or every diagnostic or therapeutic procedures that might have to be taken in future. This type of consent is invalid.

Proxy/surrogate consent: Consent given by a relative, next to kin or friend in cases where the patient himself cannot give like in case of consent taken for a person of unsound mind.

Exceptions to the informed consent:

Emergency (Section 92 I.P.C.): In an emergency condition it is usually assumed that the patient will give consent. In these cases, the consent is taken as implied.

Therapeutic privilege: In this category the physician can be excused of obtaining informed consent when disclosure of information could have a detrimental effect on the patient.

Informed refusal: The doctor has a duty to inform the patient that he has a right to refuse the treatment or investigations to be undertaken. After listening to the doctor, the patient can refuse to consent for the proposed investigation/treatment.

The consent should be full, free, voluntary, clear, informed, and direct. There should be no undue influence, fraud, and misrepresentation of the facts, compulsion and threat of physical injury, death, or other consequences. The doctor should inform the patient that he has the right to refuse to submit himself to the examination and that the results may go against him /her.

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