Patient-centered informed consent in surgical practice.
OBJECTIVE
To review the medical, ethical, and legal basis of the doctrine of informed consent for surgery and its complications, particularly for an incapacitated patient who requires a surrogate decision maker; to discuss the elasticity of the consent doctrine, whether surgical consent encompasses consent for surgical complications, and emphasize the importance of communication and shared decision making in the context of the patient-surgeon relationship; and to discuss patient and surrogate refusal of treatment, standards of surrogate decision making, barriers to effective communication, the role of the hospital ethics committee in resolving disputes over treatment, and how to reconceptualize surgical consent in the context of patient-centered medicine.


METHODS
We reviewed PubMed citations for informed consent in surgery, patient-physician communication, shared decision making, patient-centered medicine, and consent guidelines published by specialty societies, particularly the American College of Surgeons and the Society for Critical Care Medicine.


METHODS
We selected articles in which issues of consent for surgical treatment were discussed or measured.


METHODS
We extracted data relevant to questions of consent in surgical practice.


RESULTS
We studied qualitative aspects of the consent doctrine.


CONCLUSIONS
Surgical consent is not an event or a signature on a form but is an ongoing process of communication that continues throughout preoperative, perioperative, and postoperative care. In the context of patient-centered medicine, consent is best conceptualized as shared decision making with patients or their surrogates.
Bernat
James L
JL
Neurology Section, Department of Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, 1 Medical Center Drive, Lebanon, NH 03756, USA. bernat@dartmouth.edu
Peterson
Lynn M
LM
D024362:Advance Directive Adherence; D003142:Communication; D003657:Decision Making; D013502:General Surgery; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D007872:Legal Guardians; D008020:Life Support Care; D010358:Patient Participation; D010817:Physician-Patient Relations; D011183:Postoperative Complications / Q000628:therapy; D019727:Proxy; D016312:Treatment Refusal; D028761:Withholding Treatment