compulsion. Section 13 of The I ndian Contract Act states that 'two or more persons are said to consent when they agree upon the same thing in the same sense'. Common meaning of consent is permission whereas the law perceives it as a contract i.e. an agreement enforceable by law.
In consent there are four separate but correlated elements that are: Capacity: Degree of ability of the patient to understand the nature and consequences of the treatment offered. Decision-making: The ability to take decisions regarding consent. Knowledge: Sufficient amount of information about the nature and consequence of the treatment has been disclosed to the patient. Voluntary: Willingness of patient to undergo treatment. .
To be legally valid all these elements must be present in the consent.
Age Soundness of mind Ability to understand Remember the information given Ability to deliberate and decide the treatment choices Believes that the information applies to the said patient and specific purpose
TYPES OF CONSENT GENERAL CONSENT INFORMED CONSENT SURROGATE CONSENT Definition: The process in which patient is informed about the routine medical and nursing care that will be provided to the patient based on which he takes decision of getting registered and admitted in the hospital.
Clinical consultation. Admission. Disclosure of information required for clinical management (confidentially). Routine medical examination (physical examination, palpitation, percussion, auscultation). Routine lab and imaging investigations. General nursing care. Diet and Physiotherapy assessment and counselling.
Definition: It is a process in which the physician provides adequate information for the patient or patient's legal representative to make an informed decision on the proposed treatment, including medications or procedure.
Mental capacity of the patient to enter into a contract (This also includes his ability to understand information given). Complete Information to be provided by doctor. Voluntary acceptance of the procedure by the patient. Should be person and procedure specific.
Condition (Disease) of the patient. Purpose and nature of intervention*. Benefits of the intervention. Risks involved. Alternatives available. Prognosis in the absence of intervention. Immediate and future cost. *The knowledge regarding the intervention should be in an understandable language and format so that decision in the form of authorization by patient can be made. Definition - This consent is given by family members for minors or dead. Generally, courts have held that consent of family members with the written approval of 2 physicians sufficiently protects a patients interest. Informed consent obtained after explaining all possible risks and side effects is superior to all other forms of consent and legally defensive.
Simple medical examination the minimum age of consent is 12 years. For consenting to have any major diagnostic or therapeutic procedure or surgery the age is above 18 years (I.P.C. Sections 87-93). The patient should be mentally sound and he/she should not be under any fear or threat or any false conception. The patient should not be intoxicated or sedated. Incomplete information about the patients diagnosis, therapeutic plan etc. is a commission than misconception of omission. When a person is incapable of giving consent a substituted consent can be taken from the next of kin. Generally accepted order is spouse, adult child, parents, siblings, and lawful guardian.
Donation & Transfusion of Blood & Blood Products. Administration of Sedation. Administration of Anesthesia and/or Narcotic analgesia. All Invasive, Surgical and High Risk Procedures /Treatment. Research Activity. Endoscopy (e.g., bronchoscopy, colonoscopy, cystoscopy, laparoscopy);
Require injections of any substance into a joint space or body cavity, including any nonvascular space. For HIV testing. Aspiration of body fluids through the skin (e.g., arthrocentesis, bone marrow aspiration, lumbar puncture, paracentesis, thoracentesis). Biopsy (e.g., breast, liver, muscle, kidney, genitourinary, prostate, bladder, skin). Central vascular access device insertion (e.g., arterial line, Swan-Ganz catheter, percutaneous intravascular catheter (PIC) line, Hickman catheter)
53(1) Cr PC: In criminal cases when examination of an arrested person can lead to vital evidence related with the commission of crime, he can be examined by the doctor without his consent and even using force, if the application for examination is from a person not below the rank of sub Inspector. Section 54 Cr PC: An arrested person can also request to be examined by a doctor to detect any evidence which he feels is good for him. Section 87 IPC: A person above 18 yrs of age can give consent to suffer any harm if the act is not intended and not known to cause death or grievous hurt. Section 89 IPC: A child under 12 yrs of age or a person of unsound mind cannot give consent to suffer any harm for an act which may cause grievous hurt or death even if done in good faith , but the consent has to be obtained from the guardian of the child or insane person.
Section 90 IPC: Consent given by an insane person or given under fear of injury, death etc. or due to misconception of a fact is invalid.
Section 92 IPC: Any harm caused to a person in good faith even without the persons consent is not an offence if the circumstances were such that it was impossible to obtain consent of the person or his lawful guardian at that material time for that thing to be done for the benefit of the person. However the act should not extend to intentionally causing hurt other than for preventing death, grievous hurt or curing of disease or infirmity. Consent of both spouse required in case of sterilisation and Artificial insemination.