Informed consent: results of a study in a geriatric surgery division

Background

Informed consent is a process during which the physician informs the patient of his diagnostic and treatment options; informing the patient about the risks of the procedure as well the benefits, can help him/her to make a rational decision regarding his health. A paternalistic relation between the physician and the patient is antithetical to the concept of informed consent [1]. In elderly patients’ impaired decisional capacity, observed in relation to the presence of neurological pathologies like Alzheimer disease and associated disorder [2], can influence the collection of a valid informed decision.

The capacity in elderly patients of a surgery geriatric division was evaluated to discuss the possible implications from an ethical and legal point of view of a correct collection of an informed consent

Patients and methods

The study is conducted on 100 patients aged over 70 years, hospitalized in a geriatric surgery division during the period September - November 2009. The methodological approach is based on the following steps: 1. analysis of medical documentation; 2. anamnesis; 3. collection of data concerning education, previous informed consent, knowledge of diagnostic and treatment options; 4. clinical-behavioral examination by means of administration of Mini-mental state examination (MMSE) and clock drawing test. The collected data are recorded in a database.

Results

Preliminary results in some cases highlight impaired cognitive functions that could influence the expression of a valid informed consent.

Conclusions

Informed consent is relevant from an ethical and legal point of view. The analysis of the data highlights the importance of the physician – patient relationship in the collection of the informed consent. In some cases the physician should be aware of the possibility of identifying the patient’s characteristics associated with impaired capacity; in such cases formal capacity evaluations and/or enhanced consent procedures may be most appropriate.