This document discusses informed consent in surgery. It outlines the general principles of informed consent, including that consent must be given voluntarily by a competent patient who understands the risks and benefits of the proposed treatment. The document also covers the different types of consent and how consent is obtained, including providing full disclosure of the procedure to the patient. Special considerations for obtaining consent from children, unconscious patients, and those with mental illnesses are also reviewed.

1. INFORMED CONSENT IN
SURGERY
DR. IZEVBEKHAI FELIX U.

2. OUTLINE
• Introduction
• General principles
• Types of consent
• Process of obtaining informed consent
• Consent in children, unconscious patient and
mentally ill
• Consent in Jehovah’s Witnesses
• Special consideration
• Consent form
• Conclusion

3. INTRODUCTION
• Consent simply means agreement/permission
• Informed consent is the process in which a
healthcare provider educates a patient about
the risks, benefits, and alternatives of a given
procedure or intervention.
• The patient must be competent to make a
voluntary decision whether to undergo the
procedure or interventon.

4. • Both an ethical and legal obligation of medical
practitioners and originates from the patient’s
right to direct what happens to their body.
• Implicit in providing informed consent is an
assessment of the patient’s understanding,
rendering an actual recommendation, and
documentation of the process.

5. Requirements Of Informed Consent
• Subject must be competent to understand and
decide
• Subject has received full disclosure
• Subject comprehends the disclosure
• Subject acts voluntarily
• Subject consents to the proposed action

6. GENERAL PRINCIPLES
• Obtained prior to a procedure
• Sedation free
• Obtained by a qualified clinician
• Not under coercion
• No alteration should be made
• Should not exceed authority given
• In emergency, clinicians may undertake any
procedure to save life
• In elective procedures, ample time is needed

7. TYPES OF CONSENT
• Implied consent
• Expressed consent

8. • Implied Consent: verbal agreement to
undergo procedure with no associated risk eg
physical examination.
• Expressed Consent: can be oral or written, the
latter is more genuine.
• In minor procedures, verbal consent is
sufficient. In major procedures, written
consent must be obtained

9. OBTAINING INFORMED CONSENT
• Clinician should introduce himself to the patient
• Assess the patient’s level of understanding of the
procedure/ pathology
• Explain to the patient freely
• Re-emphasize the diagnosis and the natural history of
the disease with and without treatment
• Give treatment options and types of anaesthesia
• Explain the purpose of a proposed investigation or
treatment
• Describe the likely benefits and probability of success,
cost, and long-term follow-up if needed

10. • Describe any possible adverse effects; fertility,
potency, continence, etc
• Explain procedures using diagrams and patient
information sheets
• Information given is influenced by patient’s
understanding, educational, social background
and translation if necessary
• The help of another healthcare professional
may be needed

11. • Ask patients if they have understood and give
room for questions
• Answer questions honestly
• Make sure patient reads consent and signs it
• Clinician should sign the form, print his name
and date.

12. SURGICAL BIOETHICS AND CONSENT
• Ethics is an accepted way of doing things.
• Surgical bioethics are
• Principles of bioethics
– Autonomy
– Beneficience
– Nonmaleficience
– Justice

13. • Autonomy- all persons have intrinsic and
unconditional worth. Each person has a right
to self determination and reserve the power
to make moral choices.
• Informed consent
• Truth telling
• Confidentiality
• Exceptions to autonomy
• Children except emancipated minors
• Persons with developmental, physical or mental
incompetence.

14. Decision makers
• Above 18 years
• Waived consent
• Emancipated minor
• Legal surrogate

15. CONSENT IN CHILDREN
• Under 18yrs of age
• Cannot provide informed consent
• Written consent is required from the parent/guardian
• Not termed ‘informed consent’ but ‘informed
permission’
• If surgeon believes proxy’s decision not in child’s best
interest, child can be made a ward of court and
appropriately treated
• Exceptionally, adolescents(14-16yrs) consent
adequately if sufficiently mature

16. • Exception to this rule is a legally emancipated
child who may provide informed consent for
himself
• Examples of emancipated minor:
• Under 18 and married
• Serving in the military
• Able to prove financial independence
• Mothers of children(married or not)
• All subject to the laws of the state, however

17. CONSENT IN UNCONSCIOUS PATIENTS
• Surgeon may treat if procedure is life-saving
• Consent of relative/friend not required
• No legal proxy for adult

18. MENTALLY ILL/HANDICAPPED
• Not competent to consent
• If detained under mental health act, only procedures to
preserve life can be performed
• Surgeons and psychiatrists must agree that treatment
is in patient’s best interest
• No one can give or withhold consent on behalf of
mentally incapacitated patient
• If patient is unwilling to have treatment, then it should
not be performed
• Mentally ill patients have same rights as other patients

19. CONSENT IN JEHOVAH’S WITNESSES
• In emergency life threatening situation, the
surgeon will have to proceed with an acceptable
alternative
• In elective situation, the surgeon has the right to
refuse to treat
• Patient must be fully counselled as to the
possible dangers of their action and must sign a
specially prepared consent form noting all these
• All discussion must be clearly documented in the
notes

20. • After discussion with the patient, the
management plan must be communicated to
all staffs responsible for the patient

21. SPECIAL CONSIDERATION
• In procedures that involve sensitive body
function, eg amputations, colostomies,
prostatectomies, etc
• Consent must not be from a third party
• Ample time should be given to a patient to make
decisions
• Consent must be signed more than once and at
different occasions
• Pictures and video taping
• Confidentiality all through

22. CONSENT FORM
• Should contain the following items:
• Name of the hospital
• Patient’s name, address and signature
• Hospital number
• Name of the procedure
• Surgeon’s name and signiture
• Anaesthetist’s name and signature
• Name and signature of the relative as witness
• Date and time of taking the consent

23. CONCLUSION
• Consent is a legal tool for the surgeon
• It should not be neglected
• Thoroughness is of essense and should be a
continuous process pre-, per-, and post-
operatively

24. References
• Slim K, Bazin JE. From informed consent to
shared decision-making in surgery. J Visc Surg.
2019 Jun;156(3).181-184
• Shah P, Thornton I, Turrin D, et al. Informed
consent. [Updated 2022 June 11]
• Bashir Bin Yunus. Compendium for surgery
tutorials.

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