A 55-year-old man is scheduled to have electrode implantation surgery for the treatment of advanced Parkinson disease. Three days before the procedure, the surgeon discusses the details of the operation, including associated risks and benefits, as well as alternate treatment options. The patient expresses understanding of the discussion and signs the consent form. In the preoperative room on the day of the procedure, however, he becomes anxious and nervously says, "I can't do this, doctor. I'm sorry. I don't want to have the surgery anymore." Which of the following is the most appropriate course of action?

Question

A 55-year-old man is scheduled to have electrode implantation surgery for the treatment of advanced Parkinson disease.  Three days before the procedure, the surgeon discusses the details of the operation, including associated risks and benefits, as well as alternate treatment options.  The patient expresses understanding of the discussion and signs the consent form.  In the preoperative room on the day of the procedure, however, he becomes anxious and nervously says, "I can't do this, doctor.  I'm sorry.  I don't want to have the surgery anymore."  Which of the following is the most appropriate course of action?

Quizplus · Accepted Answer

11ec160b_3661_72b7_9249_8bc0681ee2ae_MD0001_00 Voluntarily given informed consent is a prerequisite for proceeding with any nonemergency medical treatment. In this case, informed consent was obtained 3 days prior, but the patient now states that he does not want the surgery. Patients have the right to withdraw consent at any time. When patients change their minds and refuse treatment, it is the physician's responsibility to engage them in a new discussion of informed consent or informed refusal. This patient has likely developed concerns about the procedure that were not discussed or fully addressed in the initial informed consent process. The best approach is to ask him what has changed and to explore his specific concerns related to the surgery in a nonjudgmental fashion, without pressuring him to reconsent. (Choice A) It would be inappropriate to medicate the patient without first assessing his concerns. Sedative drugs have cognitive effects that may impair the patient's capacity to give informed consent or refusal. (Choice C) Rescheduling the operation without first addressing the patient's concerns and conducting a new informed consent process is inappropriate. (Choice D) Reviewing only the benefits of the procedure and the risks of no treatment may pressure the patient to reconsent. An informed consent discussion must also include the risks of the procedure and the risks/benefits of alternate treatments. (Choice E) This patient has withdrawn consent for the procedure, making his signed consent no longer valid. The physician cannot proceed with surgery. Educational objective: Patients have the right to withdraw consent for a procedure at any time. When patients change their minds and refuse treatment, it is the physician's responsibility to engage them in a new discussion of informed consent or informed refusal. __________ References: Informed consent in clinical practice and literature overview. (http://www.ncbi.nlm.nih.gov/pubmed/22773162) Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. (http://www.ncbi.nlm.nih.gov/pubmed/23832767)

A 55-Year-Old Man Is Scheduled to Have Electrode Implantation Surgery