Patient Consent, the Anaesthetic Nurse and the Peri-operative Environment: Irish Law and Informed Consent

Abstract

C onsent is a fundamental prerequisite for all medical treatment. Patient autonomy, respect for such autonomy and the right to information underpins this concept of consent [Barneschi et al, 1998; Madden, 2002; White, 2004]. Patients have a right to make their own decisions about their medical care, basing this decision on the information provided to them by the healthcare professionals responsible. Corollary to this right to make their own decisions is the right to information; in that information is necessary to enable patients to make an informed decision. Informed consent is recognised as an important legal and ethical principle in health care [Kennedy and Grubb, 2000; Madden, 2002]. Now, more than ever, patients are willing to challenge professional medical opinion regarding all aspects of their healthcare and healthcare treatment. Patients are no longer unquestioningly deferential to ‘doctor’s orders’. In today’s society people are more likely ‘to act like a suspicious consumer rather than an unquestioning patient’ [Haug and Lavin, 1983]. These patients demand a ‘right to information, [and a] right to decision making’ and are more than willing to challenge physician authority [Haug and Lavin, 1983]. As a consequence, dissatisfaction regarding the lack of information given about medical treatment, along with the rise of the ‘active citizen’ [Salter, 2000] and socalled patient consumerism in healthcare, can and does result in litigation [White, 2004]. Right of access to information, the right to consent to medical treatment and the ever constant threat of litigation therefore render it necessary for anaesthetic nurses working in the peri-operative environment to have a knowledge and understanding of the legal requirements for a valid and informed consent. The purpose of this article is to discuss the law relating to consent that must be taken into account by those anaesthetic nurses in the peri-operative setting, focusing in particular on Irish case law. This article will identify the components essential for the formation of a valid and informed consent, and will examine how a patient’s capability and competency affects the legal, ethical and professional requirements of obtaining valid consent. First, a brief overview of the various sources of law in Ireland is given here to help the reader understand the nature of Irish law and the reason why Irish courts can refer to cases from other common law jurisdictions.