Chapter·Patient SafetyInformed consent

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1

A 5-year-old child is brought to the emergency department after being hit by a motor vehicle on the way to school. According to paramedics, the child's right leg was severely crushed in the accident. After evaluation, the physician recommends immediate limb-saving surgery to preserve the leg and prevent complications. However, the parents refuse to consent to the surgery. They explain that they heard about a similar case where a child died after limb-saving surgery, and they believe the procedure might lead to amputation or death. Despite the physician's explanation that the surgery is intended to save the limb, the parents remain adamant in their refusal. What is the next best step?

AContact the next of kin

BAsk for a court order

CTake into account the child’s wishes

DTake the parents' wishes into account

EInform the hospital Ethics Committee, state authority, and child protective services, and obtain a court order to proceed with treatment

2

A 29-year-old man is admitted to the emergency department following a motorcycle accident. The patient is severely injured and requires life support after splenectomy and evacuation of a subdural hematoma. Past medical history is unremarkable. The patient’s family members, including wife, parents, siblings, and grandparents, are informed about the patient’s condition. The patient has no living will and there is no durable power of attorney. The patient must be put in an induced coma for an undetermined period of time. Which of the following is responsible for making medical decisions for the incapacitated patient?

AThe spouse

BAn older sibling

CPhysician

DLegal guardian

EThe parents

3

A 32-year-old man visits his primary care physician for a routine health maintenance examination. During the examination, he expresses concerns about not wanting to become a father. He has been sexually active and monogamous with his wife for the past 5 years, and they inconsistently use condoms for contraception. He tells the physician that he would like to undergo vasectomy. His wife is also a patient under the care of the physician and during her last appointment, she expressed concerns over being prescribed any drugs that could affect her fertility because she would like to conceive soon. Which of the following is the most appropriate action by the physician regarding this patient's wish to undergo vasectomy?

AExplain the procedure's benefits, alternatives, and potential complications

BRefer the patient to a psychotherapist to discuss his reluctance to have children

CDiscourage the patient from undergoing the procedure because his wife wants children

DInsist that the patient returns with his wife to discuss the risks and benefits of the procedure together

ECall the patient's wife to obtain her consent for the procedure

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