CONSENT IN MEDICAL PRACTICE The word CONSENT is both verb and noun mean “agree or to say yes”
CONSENT IN MEDICAL PRACTICE
The word CONSENT is both verb and noun
mean “agree or to say yes”
Provision of treatment is an impliedcontract between doctor and patientand the situation is governed under
civil law
Conventional rule of conduct
Any physical contact or applicationof force without prior permission is
assault / battery
Patient is not obliged to submit anddoctor can not impose treatment without
Permission / Consent
Note: Contagious / dangerous disease for others
Permission does not absolve the doctor from his duty:
•Care and skill•Professional secrecy
(Rule of law while in professional relationship)
Note: Procedures during diagnosis / examination are considered as part of the medical treatment
Legal Position:
No specific law. Situation governed under Contract act 1872:
Sec 13. “Consent”
Two or more persons said to consent when they agree upon same thing in the same sense
Legal Position:
Sec 14.“Free consent”
Consent is said to be free when it is notcaused by:
a.Coercionb.Un due influencec.Fraudd.Misrepresentatione.Mistake
Age of consent
Age of majority
Consent taking procedures(Standard Procedure)
Consent should be:
• Full • Free • Without fear and • Fraud• From the patient or person in charge of patient
Consent taking procedures(Standard Procedure)
Having consideration of Age, Mental state, any influence on patient ( physical / disease / drug )
• Before the actual start of examination / treatment
• Extent of explanation
Doctrine of informed consent
Understandable communication between doctor seeking consent and the person entitled by law to grant consent
Legal duty rest upon doctor to make the patient understand
Doctor should inform the patient:
Doctrine of informed consent
1. Diagnosis—marginal discretion
2. Choice of treatment
3. Doctor’s experience in rendering the treatment
4. Methods which will be used
5. Major and collateral risk involved
6. Hospital stay (if any) with attendant pain or discomfort
7. Alternate to the proposed treatment
8. Prognosis
9. Probable results of the foregoing treatment
10. In case of new or un-orthodox procedure a great duty of disclosure exists and the doctor must make this exceptionally clear to the patient. If the patient makes inquiry of any pertinent matter, doctor should readily respond with a specific and detailed answer
Doctrine of informed consent
Types of consent:
According to situation / circumstances i.e. emergency or otherwise
• Implied• Expressed Oral / Written• Blanket
Note: All are valid in the eyes of law but for evidential purpose, Expressed Written is necessary
CONSENT FORMI, (name of the consentee) NIC number (of the consentee) do hereby consent to (my own / relationship with the patient) operation of (name of operation) under (type of anesthesia) anesthesia.
I have been explained fully the nature, purpose and inherent risks involved in this surgery and the type of anesthesia by Dr (name of the doctor taking consent)
No assurance has been given to me that any particular surgeon will perform the operation
Signature of the consentee Date
I confirm that all relevant detail in respect of the above referred operation and anesthesia have been fully explained to the consentee who has signed this form
Signature of the doctor taking consent Date
Situations / modifying factors(modified Procedure)
Infant / Minors / Religious faith
Christians Jehovah’s WitnessMuslims Alcohol, Morphine
Situations / modifying factors(modified Procedure)
Unconscious patient
Patient’s health interests are superior to legal formalities
Situations / modifying factors(modified Procedure)
Married patients(Especially when treatment involves organs of generation)
• Provision of oral contraceptives to treat menstrual irregularity, avoid pregnancy• IUDC to save mother’s life, avoid pregnancy• Surgical sterilization of minors, majors• Artificial insemination i.e. AIH / AID
Lunatic / Mental patient
• Lunacy Act 1912 and modification there under
• Mental Health Ordinance 2001
Situations / modifying factors(modified Procedure)
Consent in real emergency
Exception to the doctrine of informed consent
Situations / modifying factors(modified Procedure)
Consent in organ transplantation
In no case the organs be removed from un-accompanied body
Situations / modifying factors(modified Procedure)
Consent in medico legal cases
Dead: State / Next of Kin
Live: Oral or Expressed Written consent + Third party
Implied consent cannot be assumed