Informed Consent: an Update
Anasthesiol Intensivmed Notfallmed Schmerzther, 25 Jul 2019; 54(7-8) pp 457-473
An indication for a medical intervention alone is not sufficient to justify its implementation. In addition, consent has to be obtained from the patient who has been given relevant information by a doctor. If, instead of the patient, other persons are entitled to decide for him (parents for children incapable of consent, authorised representatives, carers), they must be informed. If the patient, who is aware of the significance of his decision, refuses to consent to the measure as a whole or to parts of it, the physician is bound by it – even if the patient’s refusal is based on religious, ideological or other reasons which are not comprehensible to the physician. In urgent cases, and in the case of a patient unable to give consent, the doctor can initiate treatment according to the principle of so-called presumed consent. The physician must inform the patient about all circumstances essential for the consent in a timely and comprehensible manner, i.e. also in the language of the patient in the case of patients who do not understand German. The patient must be informed about alternatives if there are other common treatment methods that are medically equally indicated, but which carry substantially different burdens, risks or chances of recovery. From a medical and forensic point of view, risk education is of the greatest importance, in particular information about the typical risks specific to interventions which are unknown to the patient and which, if they materialise, might have a lasting adverse effect on the patient’s lifestyle. The extent of risk disclosure is influenced by the urgency of the intervention; the scope of risk disclosure is in inverse proportion to its urgency. An enlightened or otherwise adequately informed patient (e.g. in the case of a series of dressing changes under general anaesthesia) does not have to be enlightened every time, provided that the risk spectrum for the patient has not changed. Consent and clarification are also verbally effective, written form is strongly recommended for reasons of preserving evidence. However, the patient’s right to self-determination also means that the patient can expressly dispense with more detailed information. Such a waiver should be carefully documented.
Editor’s note: This is a German language publication.