Informed Consent and Advance Directives

Principles of Informed Consent and Provider Responsibilities

Informed consent is a legal process whereby a client gives voluntary permission for a specific treatment or procedure. To be legally valid, this agreement must be given voluntarily without coercion or undue influence. The healthcare provider performing the procedure is legally responsible for obtaining informed consent. It is not the role of the nurse to conduct this comprehensive discussion or secure the initial agreement.

During the informed consent discussion, the provider performing the procedure must explain the procedure itself, potential benefits, material risks, and alternative treatment options. The provider must also inform the client of expected outcomes and the potential consequences of refusing the procedure. For example, if a client is scheduled for a surgical intervention, the provider must present the expected therapeutic results, what might happen if the surgery is declined, and other medical avenues that could be pursued.

A client must have decision-making capacity and legal authority to provide informed consent. When an adult client lacks decision-making capacity or legal authority, an authorized surrogate generally provides consent. An exception occurs in life-threatening emergencies where a client is unconscious and no surrogate is available; in such instances, implied consent applies. Implied consent legally assumes that an incapacitated client would consent to emergency life-saving care. For minors, a parent or legal guardian generally needs to consent to medical procedures unless a specific exception under state law applies. An emancipated minor may generally consent to their own medical care, subject to state law. Additionally, state laws may allow minors to consent independently to specified services, such as care for sexually transmitted infections, contraception, or substance use, though the permitted services and age requirements vary.