Re: Few questions on Informed Consent of Patients

[Guest guest]

Hi,

Since these questions also remain unanswered, I am trying to answer them. Hope

our young moderator will allow.

On the Informed Consent:

1. If an informed consent has not been sought from a patient before a

medical proceedure, where lies the burden of proof if a patient lodges a

complaint to this effect. Does it lie on the patient or on the physician?

Ans: It is the doctor who has to produce informed, witnessed, signed, and dated

consent in vernacular language.

2. Does consent to enter into a contract for medical treatment mean the same as

consent to the medical treatment itself?

Ans: No. The two seem different.

3. Does consent once granted imply consent to each and every medical

action?

Ans: No,the consent obtained is for specifics and can not cover other things

which are not included in previous consent. There is nothing like " blanket

consent " .

4. Can consent once granted be revoked at any time?

Ans: Yes. It is the right of the consent giver. He/she can revoke it without any

strings attached.

5. Under what circumstances can duty of medical care override the

principle of consent?

Ans: During emergencies, disasters, natural calamities, to save the lives.

6. What should a surgeon do if while performing an operation he suddenly feels

the need to perform an additional proceedure or some innovation for which he has

not sought a prior informed consent?

Ans: I think the surgeon can go ahead and do it in the best interest of the

patient but should be able to justify it later.

7.Can a physician presume consent to have been granted if the medical

action itself or its consequences are not major ones?

Ans: No. Consent has to be there.

8. Can presumed consent ever be deduced by a physician from the

patient's behaviour?

Ans: No.

Geer, let me know my score!

Vijay

[Guest guest]

Respected Vijay Sir:

Besides being owner of this group, you are the most dynamic and vibrant

NetRUMian too, who am I to allow or stop you from answering, please don't

embarrass me Sir. In fact we have been badly missing your crisp comments over

the past four days of this discussion. So far as scoring your answers is

concerned, there too I feel handicapped to judge you or any other member (who

are all much more qualified and experienced than me). I will just put forth my

answers as per my limited knowledge and request your goodself and other members

to please correct me, wherever required.

My Answers are as under Sir:

1. If an informed consent has not been sought from a patient before a

medical proceedure, where lies the burden of proof if a patient lodges a

complaint to this effect. Does it lie on the patient or on the physician?

Ans: Yes it is the doctor who has to produce the informed, witnessed, signed,

and dated consent in vernacular language, but in the court of law burden of

proof always lies upon the complainant/plaintiff, patient in this case. In my

next post I will explain something called as " Res ipsa loquitor " that exempts a

patient from the burden of proof.

2. Does consent to enter into a contract for medical treatment mean the same as

consent to the medical treatment itself?

Ans: No. The two are different. Consent to enter into a contract means the

contract signed at the time of admission which is not the same as consent, for

instance, required for a surgical or some other procedure.

3. Does consent once granted imply consent to each and every medical

action?

Ans: No,the consent obtained is for specific procedures/interventions and can

not cover all things that a patient is subject to within a hospital. You are

absolutely right in saying that there is nothing like a " blanket consent " .

4. Can consent once granted be revoked at any time?

Ans: Yes. It is the right of the patient. As per international law, a patient

can revoke it anytime.

5. Under what circumstances can duty of medical care override the

principle of consent?

Ans: You have very right mentioned that during emergencies, disasters, natural

calamities, to save the precious lives, duty of medical care can override the

principle of consent.

6. What should a surgeon do if while performing an operation he suddenly feels

the need to perform an additional proceedure or some innovation for which he has

not sought a prior informed consent?

Ans: Again you have right said that the surgeon can go ahead and do it in the

best interest of the patient but should be able to justify it later. However

here I would like to mention the reply sent to my mail inbox by another

NetRUMian (Dr Sanjeevani Kelkar), which sounds very sensible to me, hence I deem

it in the fitness of things to paste it here for the benefit of readers.

" While operating on a patient especially laparotomy ,if i come across any other

associated serious problem , something unusual which was not suspected before

operation, i myself come out at the O.T. door call the spouse or nearest

available relative there, explain the problem myself and take a fresh written

consent & then go ahead accordingly. Generally this is the best policy which

helps in making things work better.also confidence building. "

7.Can a physician presume consent to have been granted if the medical

action itself or its consequences are not major ones?

Ans: Yes for minor, routine daily procedures like taking a blood/urine/sputum

sample for analysis, taking an x-ray, blood pressure measurement etc, a

physician can presume consent (by deducing it from the patient's behaviour)or by

seeking verbal permission at least.This answer is debatable.

8. Can presumed consent ever be deduced by a physician from the

patient's behaviour?

Ans: Yes, but only for minor things, as explained above, verbal permission is

advisable in such cases, this answer too is debatable.

OPINION OF OTHER LEARNED MEMBERS IS SOLICITED TOO.

Kind Regards

Dr Geer M Ishaq

>

> Hi,

> Since these questions also remain unanswered, I am trying to answer them. Hope

our young moderator will allow.

>

> On the Informed Consent:

>

> 1. If an informed consent has not been sought from a patient before a

> medical proceedure, where lies the burden of proof if a patient lodges a

complaint to this effect. Does it lie on the patient or on the physician?

>

> Ans: It is the doctor who has to produce informed, witnessed, signed, and

dated consent in vernacular language.

>

>

> 2. Does consent to enter into a contract for medical treatment mean the same

as consent to the medical treatment itself?

>

> Ans: No. The two seem different.

>

> 3. Does consent once granted imply consent to each and every medical

> action?

>

> Ans: No,the consent obtained is for specifics and can not cover other things

which are not included in previous consent. There is nothing like " blanket

consent " .

>

> 4. Can consent once granted be revoked at any time?

>

> Ans: Yes. It is the right of the consent giver. He/she can revoke it without

any strings attached.

>

> 5. Under what circumstances can duty of medical care override the

> principle of consent?

>

> Ans: During emergencies, disasters, natural calamities, to save the lives.

>

> 6. What should a surgeon do if while performing an operation he suddenly feels

the need to perform an additional proceedure or some innovation for which he has

not sought a prior informed consent?

>

> Ans: I think the surgeon can go ahead and do it in the best interest of the

patient but should be able to justify it later.

>

> 7.Can a physician presume consent to have been granted if the medical

> action itself or its consequences are not major ones?

>

> Ans: No. Consent has to be there.

>

> 8. Can presumed consent ever be deduced by a physician from the

> patient's behaviour?

>

> Ans: No.

>

> Geer, let me know my score!

>

> Vijay

>

[Guest guest]

respected Sir,

you get a score of 10/8 , because all the things are ve........ry well

justified, so inviting less doubts.

i agree with the explainations fully - and moreover these are the

frequent questions that an "investigator" need to answer.

regards

shilpaTreat yourself at a restaurant, spa, resort and much more with Rediff Deal ho jaye!

[Guest guest]

Hi Geer,

Thanks for the kind words. I am honoured.

Moderator has all the rights to correct because the moderator is more read on

the topic.

I stay enlightened from your reply.

Vijay

> >

> > Hi,

> > Since these questions also remain unanswered, I am trying to answer them.

Hope our young moderator will allow.

> >

> > On the Informed Consent:

> >

> > 1. If an informed consent has not been sought from a patient before a

> > medical proceedure, where lies the burden of proof if a patient lodges a

complaint to this effect. Does it lie on the patient or on the physician?

> >

> > Ans: It is the doctor who has to produce informed, witnessed, signed, and

dated consent in vernacular language.

> >

> >

> > 2. Does consent to enter into a contract for medical treatment mean the same

as consent to the medical treatment itself?

> >

> > Ans: No. The two seem different.

> >

> > 3. Does consent once granted imply consent to each and every medical

> > action?

> >

> > Ans: No,the consent obtained is for specifics and can not cover other things

which are not included in previous consent. There is nothing like " blanket

consent " .

> >

> > 4. Can consent once granted be revoked at any time?

> >

> > Ans: Yes. It is the right of the consent giver. He/she can revoke it without

any strings attached.

> >

> > 5. Under what circumstances can duty of medical care override the

> > principle of consent?

> >

> > Ans: During emergencies, disasters, natural calamities, to save the lives.

> >

> > 6. What should a surgeon do if while performing an operation he suddenly

feels the need to perform an additional proceedure or some innovation for which

he has not sought a prior informed consent?

> >

> > Ans: I think the surgeon can go ahead and do it in the best interest of the

patient but should be able to justify it later.

> >

> > 7.Can a physician presume consent to have been granted if the medical

> > action itself or its consequences are not major ones?

> >

> > Ans: No. Consent has to be there.

> >

> > 8. Can presumed consent ever be deduced by a physician from the

> > patient's behaviour?

> >

> > Ans: No.

> >

> > Geer, let me know my score!

> >

> > Vijay

> >

>

[Guest guest]

Thanks Shilpa. I would like to have the remaining two also in due course of

time. Keep passing your latest knowledge on this platform. At this age

everything is limited for me. Bless me!

Vijay

>

>

>

> respected Sir,

>

> you get a score of 10/8 , because all the things are ve........ry well

> justified, so inviting less doubts.

>

> i agree with the explainations fully - and moreover these are the

> frequent questions that an " investigator " need to answer.

>

> regards

> shilpa

>