Health care organizations must have policies for addressing informed consent procedures. An NP should obtain consent for all major therapeutic and diagnostic procedures in which disclosure of significant medical information, including major risks involved, would assist a patient in making an intelligent decision about whether to undergo the proposed procedure. Courts have extended a patient's right to informed consent to his right to informed refusal. It is imperative for providers to obtain a refusal of treatment form when a patient says no to treatment. If a patient refuses to sign a document appropriately in the clinical record, review your organization's policy on this matter.
Incompetent patients pose yet another problem with informed consent.
Incompetent patients may be affected by mental illness, mental retardation, advancing age or addiction. Throughout the country, many courts have opined that a person affected by mental illness is not necessarily incompetent to make medical decisions about his treatment. Become familiar with your state's legal definition of incompetence. Where there is doubt about the competence of a patient, the consent of the family or legal guardian is required. Expressed consent may be oral or written.