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.
