Can Consent be Limited or Withdrawn?

Informed consent is a patient's agreement with a treating physician to allow something to happen to them based on a full disclosure of risks, benefits, alternatives and consequences of refusal of treatment. The idea is that a patient has a right to decide what happens to his or her body and a decision is unable to be properly made regarding how to proceed with treatment until the patient knows the possible benefits and risks of the applicable plans of treatment.

Once a patient has heard all of the relevant information from their physician, and deemed to possess the requisite competence, they will be required to consent prior to the start of treatment. It is possible for a patient to provide consent in two ways – expressly or impliedly.

Express consent is the explicitly given permission on the part of the patient to another person, usually the treating physician. A patient may give their express consent to the treating physician by memorializing their authorization in writing or by expressing consent through voice.

Another way of giving consent is through an act that demonstrates implied consent. Implied consent is a form of consent which is not explicitly given by the patient, but is inferred from the patient's actions or inactions. They indicate their wishes, without necessarily stating them. For example, a patient that allows a doctor to begin taking their blood is likely impliedly consenting to a blood test.

Usually, a treating physician will require a patient to sign a consent form once they have rendered a decision regarding treatment. The consent form serves to signify that the patient understands their diagnosis; the purpose of the recommended treatment; possible alternatives; and the risks and benefits associated. Signing this type of form can create a sense of finality. The patient may feel like their decision has been made and there is no going back. However, this is not the case. Once provided, the consent remains valid as long as there is no change in the patient's condition, to the reason for the medical treatment, or the patient simply changes their mind.

A patient may change their mind at any time (as long as a previously agreed to procedure has not been completed) even if treatment has begun. This is because informed consent is not a one-off event, but is instead considered to be a continuing process. This means that the treating physician must continue to provide information about the treatment that the patient is receiving and must respond to any questions posed by the patient.

If a patient approved of a treatment or procedure but then later wishes to forego treatment, this is acceptable. All competent adults have the right to refuse treatment and a doctor is not permitted to impose their will on a patient to force a change of mind. When a patient refuses treatment, the law protects physicians from any legal wrongdoing in not providing that treatment since they are following the patient's orders.

If a patient wishes to withdraw their consent, they may do so orally or in writing. The reason for the withdrawal need not be disclosed. The only requirement is that the patient is of sound mind when making the withdrawal request. The oral or written notification must be communicated to the treating physician who will then likely do a couple of things before changing the treatment plan.

First, the treating physician may confirm that the patient embodies the requisite capacity to make such a withdrawal decision. Second, the treating physician will make certain that the patient understands the risks associated with the withdrawal. Finally, the treating physician will make sure that the patient's decision to withdraw their consent to treatment is documented in the patient's clinical records. The patient will then likely be asked to sign the updated clinical record to reflect accuracy.

Informed consent exists to protect the patient and their rights. At no time should a patient feel trapped or compelled to follow a treatment plan that they may have agreed to at an earlier time. Consent is to be completely voluntary, free from pressure and duress and thus, a change of mind is always permitted.

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