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  1. Treat patients and families with the grace and consideration you would want for your family.

  2. The goal of informed consent is to maximize the ability of the patient to make substantially informed autonomous decisions.

  3. Physicians are obligated to protect patient information from unauthorized and unnecessary disclosure.

  4. Patients with limited decision-making capacity should participate in decision making to the extent their capacity permits.

  5. Competent patients have a virtually unlimited right to refuse life-sustaining medical treatment.

  6. The risk of liability for honoring properly documented do-not-resuscitate (DNR) orders is no more than the risk of not honoring it.

  7. Patients opting for goal-directed perioperative DNR orders usually choose to authorize temporary therapeutic interventions to manage easily reversible events.

  8. Anesthesiologists face conflicts of interest in daily practice from production pressure, interactions with industry, and safety and quality care initiatives. Anesthesiologists need to recognize potential conflicts, characterize the potential severity of the conflict, and determine the likelihood and resultant harm of the influence or the appearance of influence.

  9. The discipline of medical ethics provides expertise in recognizing, analyzing, and managing ethical dilemmas.

  10. Anesthesiologists are obligated to "own" the advancement and advocacy of all things anesthesiology.

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The goal of informed consent is to enable patients to make substantially autonomous informed decisions.1,2 The modifier "substantial" emphasizes that the realistic goal for consent is to sufficiently, as compared to fully, inform the patient.

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Components of Informed Consent

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Decision-Making Capacity

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Patients have decision-making capacity when they are capable of making a specific decision at a specific time. Patients show capacity by understanding proposed treatments, alternatives, consequences of proceeding or not proceeding, and the ability to express a preference based on rational, internally consistent reasoning. Decision-making capacity is different than competency. The clinician at the bedside determines decision-making capacity for a specific decision, whereas competency is a legal determination of the global abilities required to provide legal and other authorizations. Adults are presumed competent.

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Anesthesiologists should pay particular attention to the decision-making capacity of patients with temporary or more permanent limitations in decision-making capacity.3 Patients with more permanent limitations in decision-making capacity should be encouraged to participate in decision making to the extent of their abilities. Sedated patients with temporarily limited decision-making capacity should be assessed for decision-making capacity with regard to the specific decision. Decisions with riskier consequences require more comprehensive decision-making capacity. In patients with temporarily insufficient decision-making capacity, anesthesiologists should delay nonemergent care until patients regain sufficient decision-making capacity.

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Voluntariness

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Physicians should only perform procedures on competent patients who participate willingly. Anesthesiologists manipulate patients by distorting, downplaying, or omitting information to influence decision making. Anesthesiologists hinder voluntariness when they chemically or physically restrain patients who have sufficient decision-making capacity.4 For example, in Shine v Vega, Shine, a competent adult, went to the hospital for treatment for an asthma attack.5 The emergency department attending Vega recommended tracheal ...

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