Sometime it has been seen that surgical team approach the patient party / attendant for a radical procedure (for example - consent taken and planned for cystectomy and introp surgeon decided to do hysterectomy) in an general anaesthetized patient. Is it valid or acceptable? The operation is elective, patient is otherwise capable to give consent when awake and consent; taking consent from attendant / party isn't against patients autonomy?
Surely this comes under clauses in the consent relating to any other procedures deemed necessary at the time of the operation
The question then then is whether or not that extra procedure is in fact necessary in the event of the patient complaining.
In many cases involving malignancy extended procedures may be required but the possibility of that should have been explained and noted in the consent process.
So yes it may well be entirely legal but should have been explained as a potentiaL
If neccessary to save a patients life or remove remove all of a tumour there would be good grounds for the procedure.
If the surgeon performs an operation to which the patient has not consented he may be liable for battery. If the patient has only been informed of the procedure involving a cystectomy then she is unlikely to have given consent to the much more radical intervention of a hysterectomy. The problem with the type of consent needed in battery lies ‘in working out when the information about a proposed treatment is so fundamental that, without it, consent must be regarded as ineffective’ SA McLean (ed), First Do No Harm: Law, Ethics and Healthcare (Ashgate 2006) 276. Would the removal of the uterus not be such a fundamental information? In any case, it is the patient herself who has to give consent and not some other member of the family unless she has agreed before the surgery that she is happy for any decision to be taken on her behalf by that other family member.
I fully agree. In any case patients autonomy should be respected. If surgeons expects some need of deviation from the planned surgery, it should be informed and noted in the consent beforehand. Under Anaesthesia and sedation, patient is incapable to give a consent. Unless life saving or granted permission beforehand by the patient, decision of any procedure on the patient is the patients right.
@Maria Kreszentia Sheppard.....many thanks indeed for a legally sound answer.
In an operating theatre we are occasionally presented with a life changing situation for which the obtained consent is possibly inadequate,and trying then to weigh up the balance of evils in working out whether or not a procedure already on-table should be extended in the light of unseen complications or findings.
Thank you for providing a degree of clarity to otherwise muddy watres.
A prudent surgeon should anticipate this kind of problem. In other words, the surgeon must address this scenario before the actual operation. The scope of what is "medically necessary" or "life threatening condition" to justify additional surgical procedure must be explained fully including the immediate family members (if okay with the patient). This important aspect of informed consent must not be delegated to residents.
The consent documents that the patients were before the surgery and were generally sent by the surgical plan in response to complications, unexpected events or unusual anatomy. However, surgeons should occasionally make the decisions of intraoperative patients that may have been discussed with the patient before the anesthetic induction. In an article, the authors of this work addressed the ethics of calling surgeons to the consultation for an intraoperative consultation, to help make a decision, or to provide the necessary technical skills to respond to unanticipated surgical challenges. The activities carried out on the site are compatible with the requirements for carrying out the additional procedures, which allow access to ethically acceptable decisions. of additional procedures. The intraoperative decisions of surgeons on behalf of patients are special because they are frequently urgent, often during the surgical procedure; son taken on behalf of a patient who can not turn back from a state of emergency of anesthesia; and they involve weighing the risks and benefits of surgery to allow the patient to wake up to participate in the decision, versus the additional risk generated by the need for a second operation and anesthesia. The authors believe that this confluence of factors makes decision-making during surgery in anesthetized patients particularly challenging and deserving of examination.
Hello Dr. Habib Md Reazaul Karim ,
I know an ENT surgeon who wrote in his consent all the expected and unexpected complications up to death even for a simple tonsillectomy.
I see that it is too much over-protection and over-defensive.
Regarding Intraoperative change of consent to do a radical surgery, yes it acceptable and legal within limits and according to the current event and situation during the operation ... because it is common to see the radiology or lab. results mislead the surgeon before the operation, so his decision preoperative is to do a specific procedure , but when he open the patient already , he finds something else that may leads him to change the procedure completely, that change of procedure into a radicalsurgery maybe for better management or maybe life saving , at that time he can take a new consent intraoperatively , and the examples for this are so many .
Best Regards For You All
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