Informed Consent in the Operating Room:
Case 1 Discussion
The surgeon has the common misconception that informed consent is somehow invalidated by the presence of specific medications. Patients who present for surgery may have taken a variety of medications, many of which can have effects on mental function. The issue is not whether the patient has been premedicated, but whether premedication has impaired the patient's ability to participate in the informed consent process.
The ethical issues involved in this case include assessment of the patient's capacity to make decisions, and whether the patient is deliberately or otherwise, being coerced into consenting for surgery. The patient's capacity to provide consent is determined not by what recent medications have been given, but by whether the patient understands the need for treatment, can listen to and understand treatment options and risks, and can then express a choice regarding their care. Respect for patient autonomy requires that we promote a patient's ability to make an "unencumbered" choice. Severe pain, by impairing a patient's ability to listen and understand, is an encumbrance to the informed consent process. Further, withholding pain medication for the purpose of obtaining consent might be coercive.
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