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Authorization
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Capacity
Disclosure
Understanding
Voluntariness
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This patient is presenting with metastatic renal cell carcinoma with cancer-related pain and an invasive surgical procedure is being considered. While his daughter would like him to proceed with the procedure, the patient’s voluntariness has not been adequately assessed; he should be interviewed alone regarding his perspective of his illness and goals of care. The core principles of informed consent include disclosure, understanding, voluntariness, and authorization. Patients must be informed about the risks, benefits, and alternatives of any intervention being considered in the context of their current condition. They must express understanding of the risks, benefits, and alternatives to treatment, including non-treatment. The patient must agree to the treatment voluntarily, without coercion. Finally, the patient must authorize the intervention, which most often is obtained through an informed consent document. This written consent can be revoked at any time by the patient. Incorrect Answers: Answer 1: Authorization is incorrect because an informed consent form has been prepared and the patient is being asked to sign it. This principle might be violated when a procedure is performed without the patient’s informed consent (e.g., a surgeon sees an incidental lipoma that is not in the field of surgery and removes it). Answer 2: Capacity is incorrect because while patients must have capacity to give informed consent, there is no evidence that this patient is incapacitated. He is able to express understanding of the risks and benefits of the procedure and does not have altered mental status. Answer 3: Disclosure is incorrect because the surgeon has disclosed the risks, benefits, and alternatives of the procedure. This principle might be violated when a viable alternative, such as no treatment, is not adequately explained to the patient. Answer 4: Understanding is incorrect because this patient has expressed understanding of the risks, benefits, and alternatives of the procedure. This principle might be violated when the patient is unable to repeat back, in their own words, the risks, benefits, and alternatives to treatment. Bullet Summary: The core principles of informed consent include disclosure, understanding, voluntariness, and authorization.
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