Surgical consent during the COVID19 pandemic: Saving lives while in crisis editorial
Evander Meneses, Mark McKenney, Dessy Boneva, Adel Elkbuli
Annals of Medicine and Surgery, September 2020; (57) pp 163–165
Open Access
Excerpt
…At our institution, all patients who are admitted are tested for COVID-19 and results return usually within 24 hours. For emergent surgeries on trauma patients near death from hemorrhage, we proceed to the operating room without consent, as is the case at any trauma center. In this situation the patient is in extremis and lacks capacity due to exsanguination and altered mental status. For urgent surgeries, however we must obtain informed consent. We follow the ACS principles for informed consent, providing the patient information pertaining to the nature of their illness and consequence of no treatment, nature of proposed operation, commonly known complications, alternative forms of treatment, and a discussion of the different types of qualified medical providers who will participate in the care [5]. At our institution, the surgical resident and attending surgeon are the initial contact to the patient and/or family members when obtaining informed consent for surgical procedures. The attending surgeon provides information to the patient and/or family members and signs the physical consent form prior to the patient rolling into the operating suite. We now additionally speak with the patient and/or family members regarding COVID-19, explaining that we are unsure how it may impact their perioperative morbidity and possible mortality. We also explain that there is a risk for transmission within the hospital as well as further transmission after hospital discharge if they were to become infected in the hospital…

Surgical Consent during COVID Pandemic: COVID Times—Surgical Consent Checklist
Toney Jose, Arya Joy
Indian Journal of Surgery, 3 August 2020
Open Access
Abstract
COVID-19 caused many countries to stop their elective procedures to allow preservation of resources for COVID-19 care. With restriction being gradually lifted, the surgical services have to face the pending burden of elective cases alongside the pandemic. The true impact of the pandemic and the COVID-19 on perioperative outcomes is still being discovered. This demands a COVID-specific consenting process in addition to the routine surgical consent, to ensure that the patients are able to make informed decisions. The first ever COVID-specific checklist for surgical consent ‘COVID times—surgical consent checklist’ is introduced. This checklist enables the surgeon to ensure that a discussion detailing the impact of COVID-19 on surgical services is made. It also acts as a documentation of the discussions carried out during the consenting process.

Virtual consent for virtual patients: benefits of implementation in a peri- and post-COVID-19 era
Subhabrata Mukherjee, Asif Raza
British Journal of Hospital Medicine, 20 July 2020
Abstract
The COVID-19 pandemic has caused major disruptions to the healthcare system, including increased reliance on virtual services, particularly clinic appointments. This leads to difficulty in obtaining informed consent; the vast majority of patients now need to be consented on the day of the procedure. To reduce problems with this process, the practice of obtaining electronic consent may be the correct way forward.

The ethics of deferred consent in times of pandemics
Comment
Rieke van der Graaf, Marie-Astrid Hoogerwerf, Martine C. de Vries
Nature Medicine, 10 July 2020
Open Access
Abstract
In the current COVID-19 pandemic, many researchers are applying to research ethics committees for deferred-consent procedures for protocols that aim either to test treatments or to obtain tissue or samples from research participants. However, the deferred-consent procedure has not been developed for pandemics. In this Comment, we interpret existing guidance documents and argue when and under which conditions deferred consent can be considered ethically acceptable in a pandemic.

Informed Consent for Emergency Obstetric Care During COVID-19 Pandemic
Short Commentary
Saswati Tripathy, Satyajit Mohapatra
The Journal of Obstetrics and Gynecology of India, 3 July 2020
Abstract
Informed consent process has become a challenging issue before surgery for any emergency obstetric care during this COVID pandemic. There is an increased risk of morbidity if there is a need of intensive care unit postoperatively and a risk of high mortality if patient has symptoms of COVID-19. Admission to intensive care unit adds on to the financial burden to the patient. Also, there is an increased risk of perinatal anxiety and depression during the COVID pandemic. When an asymptomatic carrier develops symptoms of COVID after delivery or caesarean section, the morbidity increases. So we have designed an informed consent form for patients undergoing emergency obstetric surgeries incorporating some points specific for COVID-19.

How should surgeons obtain consent during the covid-19 pandemic?
Views And Reviews
Daniel Sokol, Rupen Dattani
BMJ, 30 June 2020; 369
Excerpt
…Many surgeons are now resuming elective work, yet we are aware that some make no mention of the additional risks related to covid-19. Although the British Association of Spine Surgeons and some private hospitals have produced information sheets for patients undergoing surgery during the pandemic, to our knowledge no formal guidance has been published by the General Medical Council or the Royal College of Surgeons on obtaining consent in such circumstances. The surgical community remains unclear as to what to tell patients about to undergo elective surgery…

Consent in the time of COVID-19
Helen Lynne Turnham, Michael Dunn, Elaine Hill, Guy T Thornburn, Dominic Wilkinson
Journal of Medical Ethics, 15 May 2020
Open Access
Abstract
The COVID-19 pandemic crisis has necessitated widespread adaptation of revised treatment regimens for both urgent and routine medical problems in patients with and without COVID-19. Some of these alternative treatments maybe second-best. Treatments that are known to be superior might not be appropriate to deliver during a pandemic when consideration must be given to distributive justice and protection of patients and their medical teams as well the importance given to individual benefit and autonomy. What is required of the doctor discussing these alternative, potentially inferior treatments and seeking consent to proceed? Should doctors share information about unavailable but standard treatment alternatives when seeking consent? There are arguments in defence of non-disclosure; information about unavailable treatments may not aid a patient to weigh up options that are available to them. There might be justified concern about distress for patients who are informed that they are receiving second-best therapies. However, we argue that doctors should tailor information according to the needs of the individual patient. For most patients that will include a nuanced discussion about treatments that would be considered in other times but currently unavailable. That will sometimes be a difficult conversation, and require clinicians to be frank about limited resources and necessary rationing. However, transparency and honesty will usually be the best policy.

Leveraging Tele-Critical Care Capabilities for Clinical Trial Consent
Commentary
Kristina M. Ieronimakis, Janell A. Cain, Michael S. Switzer, David D. Odineal, Thomas K. Deacy, Michael T. O.  Stein, Rhonda E. Colombo, Christopher J. Colombo
Critical Care Explorations, July 2020; 2(7) e0167
Open Access
Abstract
A severe coronavirus disease 2019 patient admitted to our institution for medical management was enrolled in a randomized placebo-controlled trial of an investigational therapeutic for coronavirus disease 2019. We leveraged existing video-telecommunication equipment to obtain informed consent. We found video-telecommunication use closely mirrored person-to-person contact for research consent by maintaining engagement and ensuring understanding. Video-telecommunication use facilitated clinical research while minimizing unnecessary exposure to coronavirus disease 2019 and conserving personal protective equipment. Prior to the coronavirus disease 2019 pandemic, research regulatory agencies were essentially silent on the matter of video-telecommunication consent. Regulatory guidance became available during the pandemic in response to increased isolation and social distancing practices. Virtual health and telemedicine use expanded greatly during the pandemic, and this increase will likely persist after the pandemic ends. We anticipate video-telecommunication adoption and implementation for research consent will also continue to grow after the coronavirus disease 2019 pandemic is over.

Risks of COVID‐19 for surgical cancer patients: The importance of the informed consent process
Alberto Julius Alves Wainstein, Ana Paula Drummond‐Lage, Reitan Ribeiro, Héber Salvador de Castro Ribeiro, Rodrigo Nascimento Pinheiro, Glauco Baiocchi, Paulo Henrique de Sousa Fernandes, Marciano Anghinoni, Gustavo Andreazza Laporte, Manoel Jesus Coelho Junior, Vinicius Negri Dall’Inha, Alexandre Ferreira Oliveira
Journal of Surgical Oncology, 20 June 2020
Open Access
Excerpt
Since the World Health Organization (WHO) declared novel coronavirus disease‐2019 (COVID‐19) a global pandemic in March 2020, its rapidly spreading outbreak imposes an unprecedented burden on the effectiveness and sustainability of the health care system all over the world. The global debate regarding the safety and feasibility of continuing to perform elective surgery made most surgical societies suggest that nonessential elective surgery should be postponed. However, now, it is clear that cancer surgery, in general, should not be delayed for most patients. As part of the patients’ preparation for surgery, the traditional informed consent now must also address the risks of COVID‐19.

It is unquestioned that, despite the infection effect on practice, the consent process should keep the patient as the main focus. Taking that into consideration, it is the Brazilian Society of Surgical Oncology’s (BSSO) objective to present the main aspects that must be covered in a surgical Informed Consent Form (ICF) to properly inform patients how this pandemic has influenced their cancer surgery and perioperative care. Supplement 1 provides the BSSO suggested ICF, adjusted to Brazilian laws and regulations…

Research on COVID-19 in South Africa: Guiding principles for informed consent
J de Vries, T Burgess, M Blockman, N A B Ntusi
South African Medical Journal, 5 June 2020
Open Access
Abstract
Research is imperative in addressing the COVID-19 epidemic, both in the short and long term. Informed consent is a key pillar of research and should be central to the conduct of COVID-19 research. Yet a range of factors, including physical distancing requirements, risk of exposure and infection to research staff, and multiple pressures on the healthcare environment, have added layers of challenges to the consent process in COVID-19 patients. Internationally, the recognition that consent for COVID-19 research may be imperfect has led to a range of suggestions to ensure that research remains ethical. Drawing on these guidelines, we propose a consent process for COVID-19 research in the South African context that combines individual consent with delayed and proxy consent for individuals who may be temporarily incapacitated, combined with key principles that should be considered in the design of a consent process for COVID-19 research.