Committees  |   July 2015
Patients From Correctional Facilities and Informed Consent
Author Affiliations
  • Barbara G. Jericho, M.D.
    Committee on Ethics
    Vice Chair
  • Joseph F. Kras, M.D., D.D.S., M.A.
    Committee on Ethics
Article Information
Ethics / Medicolegal Issues / Committees
Committees   |   July 2015
Patients From Correctional Facilities and Informed Consent
ASA Monitor 07 2015, Vol.79, 46-47.
ASA Monitor 07 2015, Vol.79, 46-47.
A 50-year-old male presents for an urgent laparoscopic cholecystectomy. The patient has been incarcerated and arrives with the guards from the local correctional facility. While speaking with the patient, the physician anesthesiologist determines that the patient does not have decision-making capacity. The guard suggests to you that you can obtain consent from the warden of the patient’s correctional facility.
From whom should the anesthesiologist obtain informed consent for this patient’s laparoscopic cholecystectomy?
It is a patient’s right to be informed about his or her medical treatment. Because our society highly values autonomy (one of the four principles of biomedical ethics: beneficence, non-maleficence, autonomy and justice), a patient has the right to begin, continue, refuse or withdraw medical treatment. 1  Adults of sound mind are assumed to be legally competent (i.e., able to make decisions regarding their own affairs). Declaring a patient incompetent to handle one or more aspect of their life is a legal decision that can only be made by a court. On the other hand, physicians make clinical decisions every day concerning whether a patient possesses the capacity to make specific choices regarding their health care. 2  The major elements of capacity are that the individual: must possess an understanding of their situation and the consequences of having, or not having, a particular intervention as well as the risks involved; must possess the ability to reason, based in a minimally consistent stable set of values; and finally, must be able to communicate that decision to those around them either verbally or through the use of gestures. 3  Furthermore, decisional capacity is situational and is subject to change.
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