Consent, Conflict and Decision-Makers

For a patient to give consent for a treatment, intervention or procedure, he or she has to: understand what it is and understand what it means.

For example: 96-year old Helen completely understands that she’s going to have a procedure for glaucoma, but when asked to explain what that means to her, and expectations for recovery, she turns to her daughter and says, ‘You explain.’ In this case, she’s not competent to give her consent because she’s lost what’s described as ‘executive functions’. From WebMD

Executive functions work together to help a person achieve goals. Executive functions include the ability to:

• manage time and attention
• switch focus
• plan and organize
• remember details
• curb inappropriate speech or behavior
• integrate past experience with present action

The consent issue complicates End of life decisions that are already a mine-field of conflicts  – amongst siblings and or family members, and often with health care professionals. In each case the reasons are the same:

• Decisions based on what feels best for the decision-maker – not what’s best for the patient
• Not ready to ‘let the patient go’