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a power point presentation on Informed Consent in Surgery .pptx
1. CONSENT TAKING
IN SURGERY
By: Dr. GLORY ENOCHE ALAPA
House Officer
Department of Surgery UATH
Supervisor:
Dr. OKPAKO Isaac Oghenero.
Senior Registrar Plastic Surgery Division
Department of Surgery
University of Abuja Teaching Hospital Gwagwalda
Date 22/04/2024
2. Outline
Introduction
Historical perspective
Types of Consent
Components informed consent in surgery
Benefits of an informed consent
Who takes informed consent?
Who can give informed consent?
Stages of informed consent
The informed consent form
Informed consent in special cases
Factors that make a faulty consent
The UATH Experience
Conclusion
References
3. INTRODUCTION
Informed consent is the process in which a health care
provider educates a patient about the risks, benefits, and
alternatives of a given procedure or intervention and as well
as seek permission to carry out the said
procedure/intervention
The patient must be competent to make a voluntary decision
about whether to undergo the procedure or intervention.
Informed consent is both an ethical and legal obligation of
medical practitioners and originates from the patient's right to
direct what happens to their body.
4. Historical perspective
The concept of informed consent has a relative short history beginning
with a series of 4 judicial decision in the early 20th century
The first was in 1905 with the case of Mohr vs Williams
Pratt vs Davis
Rolater vs Strain
Schloendorff vs Society of New York Hospital
However it was not until 1957 when it was publicly recorded in the court
document for the case of Salgo vs Leland Standford Jr University Board of
Trustees that the name and principles of informed consent came to be and
became legally binding
5. Historical perspective – Nigeria
The professional conduct of medical doctors is guided by the Code of
Medical Ethics in Nigeria, in which Rule 19 of part A deals with
informed consent.
Most laws in Nigeria emanates from the British legal system like wise
informed consent and this is not surprising as Nigeria was a colony of
the British empire
There are not enough legal cases to set the rules for informed
consent in Nigeria a clear departure from the above was a landmark
judgment in 2001 between Medical and Dental Disciplinary Tribunal
vs. Okonkwo,
6. Historical perspective – Nigeria
In Medical and Dental Disciplinary Tribunal vs. Okonkwo, the appellant, Dr Okonkwo, was found
guilty of professional misconduct.
He had honoured the verbal and written wishes of a Jehovah’s Witness patient who refused blood
transfusion and consequently died during treatment.
The Nigerian appellate court upheld Dr Okonkwo’s appeal and the Supreme Court concurred.
The apex court ruled that an adult Nigerian has a right to refuse life prolonging medical treatment,
including blood transfusion. The court located that right in the constitutional right to privacy and
freedom of thought, conscience and religion.
The court, in defining the limits of treatment in that judgment, stated:
The patient’s consent is paramount... [Accordingly] the patient’s relationship [with the Doctor] is based on
consensus. It follows that the choice of an adult patient with a sound mind to refuse informed consent to
medical treatment, barring state intervention through judicial process leaves the practitioner helpless to
impose a treatment on the patient.
7. TYPES OF CONSENT
- IMPLIED CONSENT : Is a consent given by a person’s Action or inaction ( like
a gesture) or can be inferred from certain circumstances by a reasonable
person
- EXPRESS CONSENT : Is a consent given by a person involved directly with
explicit words or in writing
- INFORMED CONSENT : Is a consent where the person involved is aware of all
the information concerning what they are agreeing To/with and with eventual
signing to a document
8. Component of an informed consent
Diagnosis/ Clinical impression
Treatment/Intervention
Risk/complication
Alternative treatment
Prognosis
9. Benefit of an informed consent
Gives greater inclusivity to patient on their treatment
Improves treatment outcomes and compliance to post
intervention instructions
Reduces post intervention complications
Reduces the chances of litigation
Increases the institution standard in compliance with regulatory
body requirements
10. Who takes informed consent
Ideally the lead surgeon takes the consent
however a team approach is advocated where
contribution is sort from the entire clinical staff, legal
counsel, administrative and/or clinical leadership
11. Who can give informed consent
A competent person; this is defined as a person above the age of 18 years who have
cognitive and emotional maturity
Gillick consent
Health care power of attorney (e.g. Jehovah witness having a health care power of
attorney in their pocket requiring that they should not be transfused blood even
when found unconscious)
Legal guardian
Statutory surrogate
In order of priority
Spouse except legally separated
Adult child of the patient
Parent of a patient
If the patient is unmarried the patient domestic partner
Patient brother or sister
A closed friend of the patient who is familiar with the condition
For unconscious adult who does not have any of the above, Moral and legal
responsibility to act in patient best interest is considered
12. STAGES OF INFORMED CONSENT
1. Assessment of preconditions
-Patient competence and voluntariness
2. Provision of information
-Patient education
-Recommendation of a care plan
-Understanding of this information by the patient
3. Stage of consent
-Patient consenting to the surgical procedure
-Recording of this authorization
13. The informed consent Form
• The consent form must have
• A title
• Information of the consenter (Age, Sex,
Occupation, signature)
• Diagnosis of the condition
• Treatment being offered
• Express agreement that patient understands the
diagnosis, options of care, procedure/treatment,
complications prognosis
• Information of the doctor giving the consent
• Information of the doctor performing the surgery
• Information of the members of the team
• Information of Witness (Age, Sex, Occupation,
Relationship to patient, address, signature)
14. Informed consent in special cases
Informed consent in children
Informed consent in pregnant women
Informed consent from a patient with different language
Informed consent from an illiterate
Informed consent from an unconscious patient
15. Consent in special cases - Informed consent
in children
Informed consent in children
The children are generally not deemed competent hence consent
should be taken from parents or other surrogate decision maker
preferably with the assent of the child
If there is disagreement with care in regards to inappropriate decision
of the care give (e.g. blood transfusion) a court order may be sort for
16. Consent in special cases - Informed consent
in pregnant women
Informed consent in pregnant women
It is best to obtain consent from both partners however if the
treatment/research is to meet the health need of the mother the
consent of the husband is not needed.
17. Consent in special cases - Informed consent
from a patient with different language
Informed consent from a patient with different language
It is advisable to use a translator to translate to the patient own
language
The consent form may not be substituted for a version that has been
translated
18. Consent in special cases - Informed consent
from an illiterate
Informed consent from an illiterate
The consent must be properly explained to the individual and the
individual may thumb print or use a written mark as his signature on
the consent form
19. Consent in special cases - Informed consent
from an unconscious patient
Informed consent from an unconscious patient
Consent may be taken from
Health care power of attorney
Legal guardian
Statutory surrogate
The surgeon who has the Moral and legal responsibility to act in patient
best interest especially when the above are not available
20. Factors that can make a faulty consent
Mental retardation
Mental illness
Alcohol intoxication
Altered mental state
Severe brain injury
Minor
21. The UATH experience
Consent taking is a perquisite to any procedure and it is strictly
adhered to as there have not been any litigation case in view of either
not taking a consent or poorly taken consent
22. Conclusion
- The concept of informed consent is continuously evolving, and it is necessary
for the surgeon to be conversant with the application of informed consent.
- Informed consent Protects the patient’s human right and upholds a Surgeon
integrity in practicing Medicine .
- Consent obtained by fraud, under the influence of drugs or anesthetics, from
an insane person, or without giving sufficient information about the surgical
ailment, the treatment proposed, and the attendant risks to enable the patient
to understand the position fully and make an intelligent decision, is not an
acceptable informed consent.
- Informed consent should be a simple document, adaptable to most situations
23. REFERENCES
Ezeome ER, Marshall PA. Informed consent practices in Nigeria. Dev World Bioeth. 2009 Dec;9(3):138-48.
doi: 10.1111/j.1471-8847.2008.00234.x. Epub 2008 Apr 29. PMID: 18452553.
Bazzano LA, Durant J, Brantley PR. A Modern History of Informed Consent and the Role of Key
Information. Ochsner J. 2021 Spring;21(1):81-85. doi: 10.31486/toj.19.0105. PMID: 33828429; PMCID:
PMC7993430.
- Anderson, O. and Wearne, I. (2007) Informed consent for elective surgery
-Medical and Dental Council of Nigeria: Codes of Medical ethics in Nigeria.
- examination of the consent form of the Ahmadu Bello University Teaching Hospital Zaria MR3
- Federal Republic of Nigeria. Constitution of the Federal Republic of Nigeria. Apapa: Federal
printing Press; 1999.
- The Doctrine of informed consent- African online journals –YZ Lawal 2007
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