CONSENT

CONSENT


Consent

  • The term consent means voluntary agreement, compliance or permission. It may be implied or expressed

Implied consent 

  • Consent which is not written but is provided by the behaviour of the patient. (When a pt. visits or calls on the doctor with his complaints, his consent for necessary medical examination is implied.)
  • It is the most common type of consent and is legally valid. It implies consent to medical examination in a general sense but not to procedures more complex than inspection, palpation, percussion and auscultation.

Expressed consent 

  • Is one the terms of which are stated in distinct and explicit language. 
  • It may be oral or written. 
  • For majority of relatively minor examinations or therapeutic procedures, oral consent is used.
  •  It should be obtained in the presence of a disinterested third party (e.g. nurse). 
  • Oral consent when properly witnessed, is as valid as written consent, but written consent has the advantage of easy proof and permanent form.

Informed consent 

  • To be legally valid the consent that is given must be informed, that is the consent must be given after understanding what it is given for and the risk involved.
  • The doctor must therefore give full information to the patient regarding the diagnosis, nature of treatment or procedure, alternative procedures, risks involved, prospects of success, prognosis if the procedure is not performed.

Informed refusal 

  • Before refusing a particular procedure or treatment, the pt. must be fully informed by the doctor the risks or possible consequences of refusal.

Therapeutic privilage (or therapeutic exceptions)

  • Some apprehensive or neurotic patients may be harmed by giving them the full information. 
  • They may refuse the necessary treatment inspite of little risk or suffer psychological trauma from such disclosure.
  •  In such cases the doctor may use discretion as to the facts which he discloses. 
  • The doctor may obtain informed consent from a responsible relative, or in his absence obtain medical consultation and note down his decision in patient’s record, explaining his intention and reasons of the therapeutic privilage. The presence of a malignancy or an unavoidable fatal lesion may not be disclosed, if the doctor feels the pt. is not able to tolerate the news. If possible it should be explained to patients spouse or next of kin.

Important Rules of Consent

  • When a patient calls on a doctor with his complaints, his consent is implied. However, if the patient is unconscious and the case is an emergency, the doctor may examine• and treat without consent. Even in such cases care should be taken that the surgical procedures do not go beyond the minimum required to save life.
  • The consent should be broad enough to cover everything contemplated as likely to be required but the so-called blanket consent form should be avoided.
  • Consent should be obtained from the parent or guardian where a person is below 12 yrs of age. or is mentally incapable.
  • In criminal cases, the victim cannot be examined without his/her consent.
  • An accused can be examined even without his consent, if the examination is requested by a police officer not below the rank of sub-inspector.

Loco Parentis

  • If an emergency involving children arises and their parents or guardians are not available, consent can be taken from the person-in-charge of the child eg. a school teacher, headmaster, warden.
  • Consent given for commiting a crime or an illegal act such as criminal abortion is invalid.
  • If any person has donated his eyes to be used for therapeutic purpose after his death, the eyes can be removed only with the consent of guardian or legal heirs.

Exam Important

  • Explaining to the patient the nature of his disease, the proposed treatment or procedure, the alternative procedure, the risks and benefits involved in both the proposed and alternative procedure, the relative chances of success or failure of both procedures
  • In cases of emergency consent is not necessary
  • In criminal cases, the victim cannot be examined without his/her consent
  • The minimum age for giving consent for medical termination of pregnancy is  18 years
  • Assistant surgeon working in a CHC and a rape convict is brought to him by the police constable. The constable has a letter from the sub inspector of police from the concerned area requesting you to do a potency test and forensic examination of the accused. The accused refused to give consent for the examination and any further tests. A reasonable amount of force should be used if needed and examine the accused.
  • A person who has been arrested on charges of rape is brought to you. No requests for potency test/forensic examination has been produced by the police constable but the arrested person asks you to examine him and take evidences as he is innocent then Examining  the person and collecting informations and samples after getting the consent is the best scenario
  • If the government has made it compulsory for any vaccination of an epidemic  strainof infection at the earliest so as to check the spread of the disease then vaccination  mustbe done even if the person refuses & threats to sue the doctor
  • Minimum age for giving consent for organ donation in India is 18 years
  • Form of acceptable consent include Informing the patient the nature of his disease, the proposed treatment or procedure, the alternative procedure, the risks and benefits involved in both the proposed and alternative procedure, the relative chances of success or failure of both procedures
  • Form of acceptable consent includes information that In cases of emergency consent is not necessary
  • Form of acceptable consent include information that In criminal cases, the victim cannot be examined without his/her consent.
  • A school teacher gives consent for treating a child who becomes sick during a picnic away from home town. This type of consent is known as Loco Parentis
  • Consent can only be valid if it is given by a person who is sane and has attained maturity, ie. age of 18 yrs
  • For sterilization of a married person, consent of both spouse, i.e. husband and wife is required
  • In criminal cases, the victim cannot be examined without his/her consent.
  • Informed consent includes All information should be given about treatment options
  • Informed consent includes Any treatment option better than the treatment being provided should be told
  • Informed consent includes All disclosure should be done in a language that the patient can understand
  • A patient of head injury, has no relatives & requires urgent cranial decompression; Doctor should Operate without formal consent
  • 20 years old young female comes to a male gynaecologist for pelvic examination Implied consent is used
  • For MTP consent is taken from Wife only
  • Consent from guardian/husband for MTP is required if  Female is below 17 years of age
  • Termination of pregnancy up to 20 weeks can be done by medical practitioner without consulting specialist
  • Female can give consent for sex if she is above 16 years
  • Examining the patient without consent amounts to Assault
  • Consent for examination in a psychiatric patient is given by Guardian
  • A doctor while examining the patient without consent in an emergency is protected underSec. 92 IPC
  • A doctor has to do an urgent operation on an unconscious patient to save his life. But there are no relatives to take consent. He goes ahead without obtaining consent from anyone; he is using the principle of Doctrine of implied consent
  • Consent is required for Pathological autopsy
  • Blanket consent is consent taken At the time of admission to do any surgery
  • Minimum age to give consent for organ donation for therapeutic purposes is 18 yrs
  • A valid consent  is Obtained in presence of two witnesses
  • A valid consent Should not be obtained with force, fear or fraud
  • True information to be given freely in A valid consent
  • Minimum age at which female can give consent for sex by 15 year  if the female is the wife of the male counterpart.
  • Legal age of consent is 12 years
  • Punishment for criminal abortion for the women who gives consent and the performer are covered under IPC section 312
  • Under which section, police can arrest a person and ask medical officer to examine him without victims consentSec 53 IPC
  • Blanket consent is consent taken at the time of admission to do any surgery
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