Before surgery of even the most minor kind can be performed, you must give your consent in writing. If a patient is unable to do this because of age, mental confusion, or coma, the consent must be given by the nearest possible relative. The legal term for this is "informed consent," and the consent must be based on all available evidence.
Major surgery, for example, open-heart surgery or the removal of a malignant tumor, carries some risk of death during or shortly after the operation, so the decision to consent is not usually granted as quickly as in an emergency. There is no immediate urgency in terms of hours, but the likely outcome without surgery in terms of life or equality of life is again so poor that the necessity to consent is obvious.
The decision to consent to elective surgery is often the most difficult to make. Although surgery in these conditions offers relief of symptoms, the disorder itself is unlikely to shorten life. A good example of this type of surgery is a total hip replacement for arthritis of the hip. Walking may be severely limited by pain and activity generally reduced, but the patient must personally decide whether the risk carried by any form of surgery is worth taking.
If elective surgery has been recommended, you must discuss the problem with your family physician, who can give you all of the facts clearly and explain any possible aftereffects before you sign the consent form.
Another point worth remembering is that if you are undergoing exploratory surgery, for example, to discover whether a lump in the breast is cancer, the consent form may include the operation that the surgeon will have to perform if the result is malignant. The surgeon waits until the pathologist's report is returned and makes the decision either to close up the incision or to remove possibly affected tissue. It would not be practical to wake up the patient, tell him or her the result, and then reopen the wound when the second consent has been signed. But if you feel that all the consequences of the operation have not been fully explained, do not consent to a further operation, until you have discussed the matter with your physician.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Reaction of Children
A child's reaction to death depends on many factors. A child's first experience with death is often the death of a pet. A child under the age of eight cannot understand that death is irreversible and may expect the mother or father to bring the pet back to life. After the age of eight or nine, the child's understanding is usually as rational as an adult's understanding.
Care of the Dying - Moment of Death
Do not be alarmed if the patient's breathing makes a groaning or croaking sound. It does not mean that he or she is in pain. When a dying patient slips into a coma, the position of the neck and body produces the noise, which can be reduced by gently turning the patient's shoulders or body.
