Informed consent
Formal Definition
The process by which a patient with decision-making capacity voluntarily agrees to a proposed medical intervention after being informed of the nature of the procedure, its expected benefits, material risks, available alternatives including no treatment, and their right to refuse; both a legal requirement and an ethical foundation of the physician-patient relationship.
How It's Used on the Ward
"Consenting the patient" or "consent form" — getting the patient to agree to a procedure after explaining what it is and what could go wrong.
Example
""Before the central line, explaining the informed consent process: the indication is IV access for vasopressors, alternatives include peripheral IVs but adequate access is not available, risks include pneumothorax (1-2%), arterial puncture, infection, and bleeding, benefits are reliable vascular access. Patient understands and agrees. Consent form signed.""
Clinical Context
Three elements required: disclosure (material risks, benefits, alternatives), capacity (patient understands and can reason), voluntariness (no coercion). Capacity vs competency: capacity is a clinical determination made at bedside (can the patient understand, reason, appreciate consequences, and communicate a choice?); competency is a legal determination made by a court. Capacity is decision-specific — a patient can lack capacity for one decision and have capacity for another. Exceptions to informed consent: emergency (imminent threat to life, patient incapacitated, surrogate unavailable), waiver (patient explicitly declines information). Surrogate decision-making hierarchy: healthcare proxy → legal next of kin. Document consent conversation in the chart, not just the signed form.
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