MESANICO’S MAR [15-06]:The Difficulties in Securing Consent

Index Title: MESANICO’S MAR [15-06]
MAR Title: The Difficulties in Securing Consent
Date of Medical Observation: June 2015
Tag: Securing consent for a minor with no relatives
Category: Professional / Ethical – Reinforcement


A 16-year-old female approached us while we were at the Emergency Room (E.R.) one evening. She complained of right lower quadrant pain of 1-day duration. Upon physical examination (P.E.) direct tenderness was noted on the said area. Together with the history and P.E. of the patient we arrived at the diagnosis of acute appendicitis and quickly informed the patient for the need for surgery. At that time, the only companion the patient had was her live-in partner of 1 year, an 18-year-old male and his brother, a 23-year-old male. Because of this, we had trouble seeking consent for the admission and management, more so to obtain informed consent for the procedure needed to be done. We advised the patient to contact any relatives she had and inform them of her need for an operation. She told us that all of her family members were at a province up north, which would take them at least 2 to 3 days to get here in Manila. We then asked the brother of her live-in partner if he would be willing to act as a guardian for her, taking responsibility of her between now and after the operation. The brother of the live-in partner of the patient was hesitant at first but eventually gave his consent after repeated explanations. We also decided to  inform the Senior House Officer (SHO) about are predicament and that we were in need of securing consent as soon as possible in order to be able to manage the patient properly. After discussing the current situation with the SHO together with the patient and her companions, we were finally able to secure our consent and a few hours later were able to operate on the patient. The procedure was uneventful and the patient was discharged the day after.

(Physical, Psychosocial, Professional / Ethical)
 (Discovery, Stimulus, Reinforcement)

 As patients arrive at the hospital grounds, most of them are usually accompanied by those with a certain relationship with them, be it a spouse or relative, a co-worker, or even a friend. These companions play an important role when it comes to managing the patient, especially when the patient is of minor age. As established in our protocol, minors are not allowed to give their own consent, due to limited capacitance to understand their present situation. Because of this setup, those of legal age with a certain relationship with the minor-aged patient are required to act as their guardian, being the ones to give informed consent. Securing this informed consent may be one of the most important preoperative steps that need to be addressed, especially in our field of Surgery. Even if the physician has the right intentions at heart, without the permission of the patient, he or she may end up with a complaint. However, not all patients have the above mentioned ideal scenario. There are cases where a patient is just brought in by an unknown individual, or a passer-by, with no relationship whatsoever with him or her. In my narrative, our patient, who was a minor, needed an operation done, but due to the lack of an appropriate companion, we were initially faced with a predicament. Fortunately, with proper explanation and with the help of the seniors, we were able to avert the problem and manage the patient properly.

ROJoson’s Notes (17jan20):

A case for problem-solving and decision-making in securing an informed consent prior to an operation of a minor.

Exhaust all options to secure informed consent from a guardian with caution not to cause a fatal delay.   Inform and get the approval and authority of the hospital director or senior house officer if no guardian is available and there is a need to operate already.

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