It is the right and responsibility of every competent individual to advance his or her own welfare. This right and responsibility is exercised by freely and voluntarily consenting or refusing consent to recommended medical procedures, based on a sufficient knowledge of the benefits, burdens, and risks involved. The ability to give informed consent depends on: 1) adequate disclosure of information; 2) patient freedom of choice; 3) patient comprehension of information; and 4) patient capacity for decision-making. By meeting these four requirements, three necessary conditions are satisfied: 1) that the individual’s decision is voluntary; 2) that this decision is made with an appropriate understanding of the circumstances; and 3) that the patient’s choice is deliberate insofar as the patient has carefully considered all of the expected benefits, burdens, risks and reasonable alternatives. Legally, adequate disclosure includes information concerning the following: 1) diagnosis; 2) nature and purpose of treatment; 3) risks of treatment; and 4) treatment alternatives.
Depending on the circumstances, consent may take on two other forms. In cases where individuals are brought to the hospital in an unconscious state or with no decision-making capacity consent can be presumed, provided that the procedures performed are necessary and cannot be postponed until the person has regained consciousness or decision-making capacity. It also may happen that a surgeon sees the critical need of more extensive surgery in the course of an operation. In these circumstances, there may be no time to contact the spouse, parents or surrogate of the unconscious patient. For incompetent or incapacitated individuals, this right and duty of the patient to give consent is to be exercised on his or her behalf by a surrogate. This is known as vicarious consent, which is regulated by individual state and federal laws, following various standards of surrogate decision-making, including substituted judgment and best interests. (See also, Ethical and Religious Directives, nn. 26, 27 and 28)