Dr Camilla Scanlan1, Professor Ian Kerridge1,2, Mr Stephen Honeybul3, Professor Cameron Stewart1,4
1Sydney Health Ethics, University Of Sydney, Sydney, Australia, 2Royal North Shore Hospital, St Leonards, Australia, 3Sir Charles Gairdner and Royal Perth Hospitals, Perth, Australia, 4Sydney Law School, University of Sydney, Sydney, Australia
Purpose: Whilst it is incontrovertible that a person’s consent is required prior to any medical intervention, and that this requirement is embedded in the law, in bioethical guidelines and in clinical practice policies, there exist some clinical situations in which the process of gaining a person’s consent raises some significant challenges which need to be considered.
Nature and scope: In most clinical situations, the process of gaining a person’s consent is reasonably straightforward, however obtaining truly informed consent in the context of surgical intervention following traumatic brain injury (TBI) can be challenging.
Problem under consideration: These challenges relate to the inability to discuss acceptable long term outcomes especially in circumstances where surgical intervention is potentially lifesaving but not necessarily restorative. In these circumstances a patient may survive with a level of neurocognitive disability and dependency that they and their families may believe to be unacceptable.
Whilst it must be acknowledged that many patients are able to adapt to a level of disability that they may have previously considered to be unacceptable, it must also be acknowledged that many survivors require considerable long-term support in order to socially reintegrate.
Conclusion; Thus, consent for neurosurgery following TBI can no longer be considered to be a straight forward process; rather it is extremely complex. What is required is honest and open dialogue not simply about the complexities and uncertainties associated with TBI but also about the intractable challenges of decision-making in this setting.
Camilla Scanlan has a long-standing interest in clinical consent. Her PhD thesis examined the legal and ethical limits of consent to high-risk medical interventions, and she has published widely on the topic.
Her on-going research interests focus on the nexus of law, ethics, and clinical practice.