Wouter Leclercq

Chapter 2 28 PRESENT PRACTICE OF SURGICAL INFORMED CONSENT Current elements of SIC Based on historical cases and legislation, IC is supported by three cornerstones: ‘‘preconditions,’’ ‘‘information,’’ and ‘‘consent’’ (Figure 2.5). Preconditions include competence and voluntariness. A patient is a person who has a right of self-determination. He/she must be able to make decisions about his/her own body and must be able to decide freely without being influenced by others. Preconditions: Competence Voluntariness Informational elements: Disclosure of information Recommendation of a care plan Understanding of this information by the patient Consent Elements: Decision by patient Authorization by the patient to proceed Figure 2.5 The elements of IC. The second cornerstone is information. According to the 1995 WHO declaration on the promotion of patients rights, patients have the right to be fully informed about their health status, including the medical facts about their condition; about the proposed medical procedures, together with the potential risks and benefits of each procedure; about alternatives to the proposed procedures, including the effect of nontreatment; and about the diagnosis, prognosis, and progress of treatment. 23 All this information must be disclosed by the surgeon to enable the patient his/her right of self-determination. A well- defined care plan incorporating the surgeon’s advice should be discussed and it must be verified that the patient understands this information.The third cornerstone is consent: registration of the patient’s decision and (written) consent. 11,24,25