title: Informed consent: ethical implications in clinical practice.
abstract: OBJECTIVE
  The concept of involving pediatric patients in medical decision-making, in both clinical and research anesthesia and surgical care, has support from specialists involved in pediatric care. Production pressure in the workplace creates conflict between ethical anesthesia practice - such as obtaining informed consent - and time efficiency. Specialized documentation of anesthesia consent may increase efficiency but could weaken the consent process. Concerns with cost containment have led to interventional quality improvement activities that may constitute research and therein require informed consent. This review discusses these three consent issues as they relate to anesthesia care.
  
  
  RESULTS
  Children are more capable of participating in medical decision-making than previously thought. Despite the call for physicians to involve children in decision-making regarding their medical care, few physicians or parents do so. Quality improvement research potentially harmful to patients, achieved without patient knowledge or consent, may violate the Nuremberg Code. Opinions differ about the potential advantages and pitfalls of specific and separate anesthesia consent forms.
  
  
  CONCLUSIONS
  Anesthesiologists have ethical obligations to involve children in the medical decision-making process as much as the child's capacity allows, and to place patient advocacy in the informed consent process above production pressures. While a specific and separate anesthesia informed consent form may be useful, it should not undermine the process of informed consent or relegate the consent process to non-physician personnel. The informed consent process for anesthesia care remains the province and responsibility of the individual anesthesiologist.
authors.affiliation: Department of Anesthesiology, University of Washington, Seattle, Washington, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Van Norman
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Jackson
authors.forename: David
authors.initials: D
authors.lastname: Waisel