Informed consent

[Greta]

Before performing any invasive test or providing medical treatment, doctors must obtain permission from a competent patient in a manner that is informed and voluntary. The process is known as informed consent. People have the right to information about risks, benefits, and alternative treatments when making decisions about medical care and the freedom to choose. (See also Overview of Legal and Ethical Issues in Health Care.)
If the patient is not capable of understanding these elements or making a decision, the doctor turns to the person named in a health care power of attorney. If none exists, the doctor may turn to another authorized surrogate decision maker. If urgent or emergency care is needed and an authorized decision maker is not immediately available, the doctrine of presumed consent applies: People are presumed to consent to any necessary emergency treatment.
Self-determination means that adults of sound mind have the right to decide what shall be done to their body. It is the foundation of the legal and ethical doctrine of informed consent. The process of informed consent should involve discussion between the individual and the doctor. Patients should be encouraged to ask questions about their condition and treatment options, and doctors should share facts and insights along with support and advice. Doctors should present the information in a way that is understandable to the patient and communicates the risks and benefits clearly. The law requires that doctors take reasonable steps to communicate adequately with patients who do not speak English or who have other communication barriers. Informed consent is substantially achieved when patients understand

Their current medical status, including its likely course if no treatment is pursued
Potentially helpful treatments, including a description and explanation of potential risks and benefits
Usually the health care practitioner’s professional opinion as to the best alternative
Uncertainties associated with each of these elements

Typically, a document summarizing the discussion is signed by the patient for any major treatment decisions.

[Magaret]

Consent of the patient is a prerequisite for any medical intervention. However, that consent often does not need to be explicit. For emergency care, consent is normally presumed, referred to as the doctrine of presumed consent. For interventions considered routine and unlikely to cause harm (eg, routine phlebotomy, placement of an IV line), circumstances are typically considered to imply consent. For example, by holding out their arm, patients are presumed to indicate consent to receive certain routine interventions. For more invasive or risky interventions, express informed consent is always required.
To give informed consent, patients must have legal and clinical capacity. Health care practitioners obtaining informed consent must be qualified to explain the risks and benefits of the intervention and to answer appropriate questions. The law requires that health care practitioners take reasonable steps to communicate adequately with patients who do not speak English or who have other communication barriers.
Ethical and legal authorities generally agree that health care practitioners are obligated to ensure, at a minimum, that patients understand

Their current medical status, including its likely course if no treatment is pursued
Potentially helpful treatments, including a description and explanation of potential risks and benefits
Usually, the practitioner’s professional opinion as to the best alternative
Uncertainties associated with each of these elements

Practitioners should be clear about the prospects of recovery with treatment and, if treatment is successful, what life will be like afterward. Generally, these discussions are noted in the medical record, and a document describing the discussion is signed by the patient.
Although practitioners are ethically bound to provide sufficient information and to encourage decisions judged to be in the patient’s best interest, patients have the right to refuse treatment. A patient’s refusal of treatment is not considered to be attempted suicide or evidence by itself of diminished capacity, nor is the health care practitioner