Informed Consent Challenges in Frail Surgical Patients

Informed Consent Challenges in Frail Surgical Patients
Book Chapter
Alessandro Feola, Antonietta Porzio, Mariavictoria De Simone, Omero Pinto, Graziamaria Corbi, Carlo Pietro Campobasso
The Frail Surgical Patient, 28 January 2025 [Springer]
Abstract
Informed consent is an essential aspect of medical ethics and the foundation of patient-centered healthcare. It represents the principles of autonomy, self-determination, dignity, and patient rights. Physicians are responsible for acquiring informed consent or dissent before conducting any medical procedure and should provide comprehensive information about potential benefits, risks, and alternatives while also encouraging patient participation in their care whenever possible. The historical evolution of informed consent has led to a new definition of the doctor-patient relationship, shifting from a paternalistic approach to one that valorizes the individual’s decision-making capacity and will. For many years, the definition of “frailty” has not been uniform: several authors consider frailty as a condition where an inadequate response to stress and a high risk of adverse outcomes, such as the onset of disabilities, illnesses, institutionalization, or mortality. Frail surgical patients encounter unique ethical and legal challenges due to their increased vulnerability. Because of their cognitive limitations, physical disabilities, and comorbidities, these patients may face complex decisions about surgical procedures. Their limited capacity to comprehend the risks, advantages, and alternatives related to surgical intervention may compromise their ability to make informed choices. To ensure the best possible outcomes, healthcare providers should conduct a preoperative frailty assessment, implement perioperative management with a multidisciplinary approach, and reduce the risk of future complications to improve postoperative care. Informed consent in frail surgical patients is a challenging aspect of medical practice that requires a patient-centered approach based on adequate information and respect for patient autonomy. Healthcare professionals must ensure that patients and their caregivers are adequately informed and supported during the decision-making process and that all discussions related to informed consent are thoroughly documented.