What is implied consent? What is expressed consent? How and when do I know which one is required?
Implied consent is inferred from the patient’s actions and surrounding circumstances. For example, a patient presents voluntarily for an examination, investigation, minor or less invasive treatment/procedure.
Expressed Consent is direct, explicit agreement to undergo a specific Treatment/Procedure(s), given either verbally or in writing. Expressed Consent in written form is obtained for only a few treatment/procedures in EMS such as the Vital Heart Program. It is prudent to obtain verbal consent also when analgesics, narcotics or anesthetic agents will significantly affect the patient’s level of consciousness during the Treatment/Procedure.
The clinical situation determines the approach required. When there is doubt, it is preferable the consent be expressed, either verbally or in writing.
Who is responsible to obtain consent when the treatment proposed will be done by a Health Practitioner other than a physician?
The responsibility for obtaining informed consent rests with the Health Practitioner who has the responsibility and accountability for the specific treatment or procedure being provided to a patient, assuming he/she is authorized by Alberta Health Services to deliver the treatment/procedure within his/her scope of practice.
How do you verify understanding of information?
During the consent process, the patient must be given the opportunity to ask questions and receive understandable answers. The type of questions a patient asks may demonstrate their understanding. The Most Responsible Health Practitioner can also verify understanding by asking the patient what their concerns are (if any), or have the patient repeat back his/her understanding of the procedure and ask if they require any further information. The Most Responsible Health Practitioner may allow, at the patient’s request, the patient’s spouse, or any relatives or friends that accompany the patient, to help the patient to understand or demonstrate an understanding of the information.
How can I determine if there is a language barrier between the patient and the Most Responsible Health Practitioner? If there is, how can I access an interpreter?
Practitioners will be sure that information is presented in the appropriate language wherever possible, in a simple and easy to understand way, and in a manner that is respectful of cultural beliefs and preferences. If the patient does not speak, all practitioners across Alberta have access to over-the-phone interpretation services in 170 languages, 24 hours a day, seven days a week.
Who is responsible to document the consent process?
The Most Responsible Health Practitioner obtaining consent shall ensure that the consent process has been followed and that the consent process and outcome are documented appropriately in the patient’s health record.
Who is able to give consent for minors if the parents lack capacity (e.g. intoxication)?
Practitioners must obtain informed consent from parents or legal representatives prior to providing care for minors. Practitioners may provide care to minors in situations where the parents or legal representatives are not present in circumstances where the delay of emergency medical care could cause significant harm to the patient. In this situation, practitioners should attempt to contact a parent or legal representative as soon as appropriate.
What do I do if the Specific Decision-Maker refuses consent? Or if they are not acting in the best interest of the patient?
It is important for the Most Responsible Health Practitioner to explain the risks and consequences of the refusal to the Specific Decision-Maker. It is prudent to have a second Health Practitioner witness the explanation and to document the refusal on the patient’s health record. If the Most Responsible Health Practitioner is concerned that the decision being made (i.e. refusal) is not in the best interests of the patient, the practitioner will call On Line Medical Consultation for direction.