Elderly patients present a number of issues for their physicians, especially in the realm of informed consent. When a patient could require ongoing care or repeated treatments, and their mental capacity can fluctuate drastically from appointment to appointment, it’s imperative that physicians confirm that a state of informed consent has been reached before beginning any procedure. Let’s take a microscope to what that looks like and how to ensure you’re not caught off guard with surprise consent issues.
What is Informed Consent?
First, a quick refresher on informed consent and its history. Informed consent emerged as an earnest legal requirement in 1914 from a New York Appeals Court case (Schloendorff v. Society of New York Hospital) wherein a woman agreed to a simple examination under anaesthetic and was then subjected to a surgery she had previously declined. Justice Benjamin Cardozo, the judge presiding the case, stated that:
“Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits an assault for which he is liable in damages.”
This statement has remained at the core of what defines informed consent ever since.
Since that case, informed consent as a legal requirement swiftly spread throughout the medical world. As more cases were brought to the courts in the century since, those legal requirements and their accompanying protections for both patients and physicians have grown appropriately more refined and complex.
Nowadays, different countries have different setups — and the states therein often have their own specific needs from both sides of the consent process. Generally speaking, doctors need to provide their patients (or someone with their power of attorney) with enough information to make their own choices about their medical care. Be sure to familiarise yourself with your state’s laws ASAP so you know what is required in your discussions with your patients.
Elderly Patients and Informed Consent
Elderly patients bring a number of complex issues into the already dense legal space of informed consent. Long-term treatments and fluctuating cognitive faculties combine to create unique situations for each patient.
Medical problems that require repeat or indefinitely ongoing treatments, such as dialysis, chemotherapy, or other radiation therapies, typically require establishing a consent check-in system with the patient. At the beginning of treatment, the patient needs to be fully informed about the process and potential side-effects and given the chance to decline or adjust treatment. Then for each subsequent appointment, that consent needs to be reaffirmed and noted in the patient’s medical record. This way, both the patient and the treatment provider are legally protected in the case of an incident. While this system is applicable to every kind of patient, elderly patients are the most common cases for receiving these treatments, and many of them also have other conditions or situations that add complex layers to the consent-giving process.
Cognitive capacity is a tough area to navigate for patients and their families, and can lead to heightened emotions in a number of scenarios. Cognitive decline can also cause a lot of mix-ups and delays with consent for medical professionals hoping to treat elderly patients. Power of attorney is the medicolegal solution to these problems, however it is an incredibly complex field that differs from state to state. As such, it’s always best to consult with your institution’s legal team and psychiatric professionals, as well as the family of the patient, before making any firm decisions about the treatment of a patient with low cognitive capacity.
Informed consent is a complex and multi-layered issue, but establishing it with a patient doesn’t have to be hard. Neeje is a software platform that allows medical professionals to build legally-sound consent forms alongside the patient, meaning each form covers the specifics of both the patient and the procedure. We have implemented a machine learning algorithm into Neeje that learns about your practice and your patients the more you use it – if you commonly treat elderly patients, your forms will adapt to cover their typical needs and wishes over time, making the informed consent process continuously easier. To start your Neeje journey today, head over to https://neeje.io/.