In the case of minor patients, legal precedents determine when a minor can give legal consent, but do not address the issues of when a minor patient should be invited ethically to participate in the informed consent process. A more detailed discussion of these issues will occur in the Pediatrics Clerkships . General rules to follow in consent for surgery and anesthesia are to inform the patient of common risks even if they are not serious, and very serious risks, such as death, even if they are not common. When discussing risks with patients, understand that mere recitation of statistical risks may mean little to patients, and it can be helpful to relate the information to risks which have some meaning for the patient. Manipulation involves incomplete or nontruthful presentation of information, such as lying, omitting vital information, or deliberately deceiving.
Manipulation is always ethically suspect.
Persuasion involves the presentation of a rational argument for a choice, and is permissible, even desirable during the consent process. Patients recognize that physicians have expertise and advice to offer about their care, and expect physicians to be forthright with recommendations. Multiple studies have failed to demonstrate differences in the way patients and observers rate the stress levels of patients who receive detailed information when compared with patients who received little or no information about risks. Conscious, competent patients have the right to make choices regarding their health care in emergencies, just as in routine care. When patients are incapacitated, it is important to seek the advice of appropriate surrogate decision makers and others who know the patient and are aware of his or her usual choices.