Consent must be valid

, which means

• given voluntarily
• given by a competent person

whereas a competent person is defined by

- the ability to understand and remember the given information

- the ability to weigh up risks and benefits of the procedure

- the consequences of not having the procedure

• appropriate information is provided (nature + purpose of the procedure, pan relief, complications/risks, alternative treatment options)
• explanation of common risks (e.g. nausea) and also    severe complications even if they are rare (e.g. nerve injury)
• patients individual experience and background are taken into account (e.g. values, social background, culture, religion, beliefs, intellect)
• documentation of the agreed anaesthetic and post-operative plan including a list of risks explained
• separate anaesthetic consent forms are currently not necessary (some departments make use of them)

Consent - special situations:

1. Refusal of treatment   

• a well-informed patient with capacity can voluntarily refuse treatment (even when this results in death)
• this has to be accepted by the health care professional

2. Advanced directive  

• refusal of treatment in advance in case of future incapacity
• written "living will" by a competent person
• are legally binding

3. Young adults (>16 years)

    - can give consent without separate consent from a parent or guardian

Young adults  (<16 years)

• can be competent to give consent (if able to understand the information provided and to outweigh risks & benefits)
• children and young adults who refuse treatment can be overridden by a parent or court
• the treatment has to be in the childs best interest
• parents can consent for children without capacity

4. In an emergency

• verbal consent by telephone is adequate
• consent is not necessary in life-threatening situations
• if a child or parent refuse treatment a court order can be obtained (but that should not delay emergency treatment)

5. In unconscious patients

• essential treatment is possible without consent
• it is good medical practice to inform the next of kin
• the next of kin can not give or refuse treatment

6. Restricted consent:

• certain aspects of treatment may be refused (e.g. blood transfusion in Jehova's Whitnesses)
• must be discussed with patients in detail so that the patient understands the consequences of refusal
• must be respected at all times
• the patient can change this decision at any time

7. Research / Teaching

• the same legal principles apply as for giving consent