Consent, Refusal of Care, and Shared Decision-Making for Pediatric Patients in Emergency Settings

Points & Pearls Excerpt

• The general consent forms that a patient or surrogate signs when entering a healthcare facility include consent to a general medical evaluation, treatment, and billing policies. The forms themselves do not constitute informed consent. While consent is implied for many medical interventions, (eg, basic examinations), additional forms may be needed for invasive procedures and treatments.
• Informed consent is a process of communication between clinicians and patients in which the indications, alternatives, risks and benefits, and uncertainties of the proposed intervention are discussed with the patient or guardian. All information that a reasonable person would want to know must be provided, including risks of rare, but serious, complications.
• Refusal of care in the pediatric population is a consideration for both the patient and parent only if the care required is not emergent and does not affect conservation of life or limb.
• Shared decision-making is a relatively recent best practice that affords a level of autonomy and allows the patient and family to be involved in decision-making when there are multiple approaches to care of the health concern.