Abstract
BackgroundRespect for patient autonomy and the requirement of informed consent is an essential basic patient right. It is constituted through international conventions and implemented in health law in Norway and most other countries. Healthcare without informed consent is only allowed under specific exceptions, which requires a record in the patient charts. In this study, we investigated how surgeons recorded decisions in situations where the elderly patient’s ability to provide a valid informed consent was questionable or clearly missing.MethodWe investigated all medical records of patients admitted to surgical departments in a Norwegian large academic emergency hospital over a period of 38 days (approximately 5000 patients). We selected records of patients above the age of 70 (570 patients) and searched through these 570 medical records for any noted clear indications of inability to consent such as “do not understand”, “confused” etc. (102 patients). We read through all the medical records on these 102 patients noting any recordings on lack of informed consent, any recordings on reasoning and process hereto. We also took note whether there were clear indications on the use of coercion.ResultsNone of the 102 included patients´ charts contained legally valid recorded assessments (for example related to the patients´ competence to consent) when patients without the ability to consent were admitted and provided healthcare.Some charts contained records that the patient resisted treatment, thus indicating treatment with coercion. In these situations, we did not find any documentation related to legal requirements that regulate the use of coercion.Discussion and conclusionWe found a substantial lack of compliance with the legal requirements that apply when obtaining valid informed consent. There are many possible reasons for this: Lack of knowledge of the legal requirements, disagreement about the rules, or that it is simply not possible to comply with the extensive formal and material legal requirements in clinical practice. The results do not point out whether the appropriate measures are amending the law, educating and requiring more compliance from surgeons, or both.
Highlights
Respect for patient autonomy and the requirement of informed consent is an essential basic patient right
We did not find any documentation related to legal requirements that regulate the use of coercion
We found a substantial lack of compliance with the legal requirements that apply when obtaining valid informed consent
Summary
Respect for patient autonomy and the requirement of informed consent is an essential basic patient right. It is constituted through international conventions and implemented in health law in Norway and most other countries. Healthcare legislation is to a much larger degree based on providing healthcare adapted to the individual patient’s preferences [2, 3]. This is operationalized through the informed consent, nationally in the Norwegian Patients Rights Act Article 4–1 from 1999 [4], in international conventions including the Convention on Human Rights and Biomedicine from 1997, Article 5 [5], and through a significant amount of national and international guidelines and directives Table 1. As a general rule healthcare personnel have to establish that the patient has competence with regards to personal-, material- and procedural requirements [6], provide adequate information, ask about the patient’s preferences, assess the patients’ competence, and avoid coercion [3]
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