Question

How does the principle of informed consent apply to competent patients who refuse lifesaving treatment? How does it apply to incompetent patients who have signed an advance directive?

Answer 1

Informed consent is the process through which health care service providers give appropriate information to a competent patient so that the patient can make a voluntary decision whether he/she wants to accept the proposed treatment or refuse the treatment. In such cases i.e. cases involving competent patients the health care service provider has to provide the patient with reasonable alternatives to the proposed intervention. The health care service provider will also discuss the applicable risks and benefits of each alternative.

In case of patients who are incompetent and have signed an advance directive. The signing of the advance directive leads to the appointment of a substitute decision maker. In case of advance directive the patient (who is now incompetent) had already identified an individual who will respect that patient’s values and hence will be able to make substitute decisions on behalf of the now incompetent patient. In such a case the principle of informed consent will be implemented on the basis of a prior discussion that has been documented or on the basis of a living will or a durable power of attorney.