An ethical everyday nursing dilemma that I have dealt with in my nursing career would be that
of informed consent. I have had many instances where I do not believe that the patient was ready
or competent enough to sign his or her consent and the surgeon would have blown a gasket if I
disagreed with witnessing the consent. There was an instance actually a week ago where a
patient fractured her bone and was in such severe pain she had gotten heavily medicated. The
surgeon came in that morning and went through the information about the operation she was
going to perform. I knew at this point she was responsive but completely out of it. She later
would not recall the events that took place that very day. I should have spoken up for her even
though I knew that should not have the surgery. Things like this happen every day.
An informed consent procedure is a convenient application of mutual decision making
between a patient and his surgeon. Moreover, nurses as they are patient's advocates, have been
trusted to fully understand the ethical and legal factors of the informed consent process. In
professional nursing practice, ethical practices are cornerstones to the informed consent.
However, before surgery, surgeons are the ones who have the ultimate responsibility for the
informed consent. For the benefit of patient surgeons and knowledgeable nurses come together
and have an ultimate completion of the informed consent. This paper will review questions to
whether the right to informed consent is unconditional by observing the philosophical, legal, and
ethical principles causing consent.
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Patients have the right to independence and respect should always be given to them and steps to
be taken for consent to be truly informed. However, there is no absolute right when it comes to
the basis of ethical, philosophical, practical, and legal considerations.
In a relationship between doctor and patient, the consent to investigation and treatment is
considered the cornerstone. Consent in The Oxford Dictionary (1998) is described “permission
for something to happen or agreement to do something”. The definition has not involved any
understanding action that is agreed and the term for medical reasons “informed consent”
implying “permission has been granted in full familiarity of possible consequences" is
developed. According to General Medical Council (GMC), it is advisable to be able to
understand and asses information as well as being able to communicate for informed consent.
In medical ethics, there are four principles justice, autonomy, non-maleficence, and beneficence.
When we consider the underlying consent autonomy is the major ethical principle. Patient’s
determination on what to be investigated and treatment to go through with should be respected
by the doctor. Patients rely on doctor's information for consents to be informed. For the process
to be valid faithfulness and honesty is vital. Making decisions to offer treatment or withhold
treatment to the patients, the ethical principle of justice must be applied. Informed consent
process is touched by this and is explored more when discussion of specified treatment is
INFORMED CONSENT 4
Not only is the issue of whether a right or principle is absolute involves ethical and legal aspects.
It also involves the philosophical argument of absoluteness. Taking the example of freedom it
cannot exist as an absolute principle because giving one person freedom will disregard the
freedom of another person considerably. Freedom of person A to take any good will have an
impact on person B’s freedom to get a property. In autonomy when these principles are applied
the same problems appear. The total autonomy of one person will have negative effects on
another person. A fair way of living is brought about by the modern democratic society by the
designed laws and rules. Hence, this will restrict autonomy, this same restricted autonomy, on
the other hand, assures the equal amount of it to all members of society. In the philosophical
basis autonomy principle for the informed consent contradicts itself in its application to society.
Autonomy is the major principle of ethical principle in informed consent there is no existence of
absolute right to consent.
The surgeon can be charged with battery if he conducts a medical procedure without a legal
informed consent. Example, if a doctor goes against the patient’s will he uses different treatment
than the one the patient consented for and giving treatment knowingly with wrong information
after consenting. The regulatory body (GMC) has set up guidance for consent. For a capable
adult, they cannot consent for UK laws are adapting consents patients with permanent incapacity,
minors, and patients who are suffering from mental illness.
For any investigation or treatment to take place an informed consent is required to be
presented to a patient. Benefits, procedure, and risks are the main bases of an informed consent.
Autonomy as a main ethical principle I maintain my stand that there is no absolute right to
INFORMED CONSENT 5
consent. It is a contradiction to consent and autonomy on a philosophical basis to an absolute
right. In the UK several restrictions to the right to consent are set by the legal body. Statuary
instrument that is mainly concerned is Mental capacity Act, Mental Health Act, and Public
Health Act. For minors, patients with mental illness, and patients with incapacity, and patients
with infectious diseases the right to consent is regulated by UK law. In special cases, their
consents are not granted or rights to consent are restricted. It is mandatory in infectious diseases
cases to have a disclosure to information with no consent. When it is expected for a patient to be
in incapacity can set directives for their future treatment when they are still competent and also
an LPA can be given the right to decide the treatment on behalf of the patient. Having a look at
the practical aspects of consent it is evident that information given is often poorly understood.
With the lack in being informed patients are giving consent. Meaning they can not give informed
consent for the lack of proper understanding. It is challenging to give an absolute right to consent
in practice if efforts to supply information that is vital for informed consent fails regularly. In
summary, the right to patient's autonomy is to be respected and action to be taken to make
consent truly informed. In the basis of ethical, legal, philosophical and practical consideration
however right to absolute consent is not valid.
INFORMED CONSENT 6
Flanagin, A. (2009). Ethical Review of Studies and Informed Consent. AMA Manual of Style.
Davis, J. K. (2004). Precedent Autonomy and Subsequent Consent. Ethical Theory and Moral
Practice, 7(3), 267-291. doi:10.1023/b:etta.0000042908.13784.00
Farrimond, H. (2013). Informed Consent. Doing Ethical Research, 109-125. doi:10.1007/978-1-