Involving patients or their surrogate decision-makers in their care is an important element of modern medical practice. General consent, informed consent, treatment refusal, and shared decision-making are concepts that are used regularly but can be more complex in pediatric emergency settings. This issue summarizes these concepts and provides case examples that may be encountered. It explains the essential elements of informed consent, the distinction between the informed consent process and the document, how to approach treatment refusal, and approaches to involving patients and their surrogates in shared decision-making. Special circumstances include treatment for sexual and mental health conditions, emancipated minors, mature minors, and situations when custody is unclear. Implementation of these concepts can increase patient satisfaction, resolve conflict, and reduce risk.
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Following are the most informative references cited in this paper, as determined by the authors.
3. * Committee on Pediatric Emergency Medicine and Committee on Bioethics. Consent for emergency medical services for children and adolescents. Pediatrics. 2011;128(2):427-433. (Policy statement) DOI: 10.1542/peds.2011-1166
5. * Cordasco K. Chapter 39: obtaining informed consent from patients: brief update review. In: Shekelle PG, Wachter RM, Pronovost PJ, et al. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville: Agency for Healthcare Research and Quality (US); 2013:461-471. (Review)
6. Agency for Healthcare Research and Quality, Abt Associates, The Joint Commission. Making Informed Consent an Informed Choice: Training for Health Care Professionals. Accessed April 15, 2021. (Training module)
7. * Centers for Medicare & Medicaid Services. Revisions to the hospital interpretive guidelines for informed consent. Accessed April 15, 2021. (U.S. government document)
9. * Guttmacher Institute. An overview of minors’ consent law. State policies in brief. Accessed April 15, 2021. (Website)
11. * Weiss EM, Clark JD, Heike CL, et al. Gaps in the implementation of shared decision-making: illustrative cases. Pediatrics. 2019;143(3):e20183055. (Case reports) DOI: 10.1542/peds.2018-3055
13. Agency for Healthcare Research and Quality. Health Literacy. Accessed April 15, 2021. (U.S. government resource)
14. * Garner BA, Black’s Law Dictionary. 9th ed: U.S.A.: West; 2009. (Legal reference)
15. * The Joint Commission, Division of Health Care Improvement. Informed Consent: More than Getting a Signature. Quick Safety. 2016(21). (Advisory article)
16. 42 Code of Federal Regulations § 482. 24 - Condition of participation: Medical record services. Accessed April 15, 2021. (Legal information)
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Keywords: consent, general consent, informed consent, consent form, informed consent process, refusal, refusal of care, refusal of treatment, shared decision-making, competence, incompetence, capacity, teach-back method, assent, emancipated minor, mature minor
Sephora N. Morrison, MBBS, MSCI, MBA, CPE, CPXP; Laura Sigman, MD, JD, FAAP
Michael J. Gerardi, MD, FAAP, FACEP; Jennifer E. Sanders, MD, FAAP, FACEP
May 2, 2021
June 1, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Ethics CME credits.
Date of Original Release: May 1, 2021. Date of most recent review: April 15, 2021. Termination date: May 1, 2024.
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