Question

A 64-year-old woman with multiple sclerosis (MS) is hospitalized. The team feels she may need to be placed on a feeding tube soon to assure adequate nourishment. They ask the patient about this in the morning and she agrees. However, in the evening (before the tube has been placed), the patient becomes disoriented and seems confused about her decision to have the feeding tube placed. She tells the team she doesn’t want it in. They revisit the question in the morning, when the patient is again lucid. Unable to recall her state of mind from the previous evening, the patient again agrees to the procedure.*

Explain your answers: Has the woman given her informed consent? Should she be judged competent? Should her final agreement to the procedure be sufficient to establish informed consent, or should her earlier waffling and confusion also be taken into account?

Answer 1

The term informed consent can be described as a process or a procedure by which the healthcare provider seeks permission of the patient before conducting any healthcare intervention during which the healthcare provider educates the patient about the risks, benefits and alternatives of the intervention. The informed consent is only considered valid if the state of mind and the ability to take rational decision is possible for the patient. In the given scenario, the patient 64 year old women in the evening was disoriented and confused and refused the feed tube intervention and this is not the legal criteria for the informed consent to be implemented. On failure to ratify informed consent, the healthcare provider again performed the informed consent in the morning and upon that the patient gave her agreement for the feeding tube. Therefore, this here is the proper and legal way informed consent performed by the healthcare providers. This can be considered valid and will not violate any informed consent criteria.

The patient changed her decision on becoming lucid in the morning and hence her competency to provide the informed consent must be assessed and taken into account. However if the patient is diagnosed of any psychiatric condition then a legally acceptable representative has to be used to obtain the valid informed consent from such patients. If the patient does not have mental illness, then she must be given ample amount of time without any drug influence to think and take a decision and only after through understanding the patient's informed consent be considered as valid or acceptable