© 2017 Bryan Aja
It is common for providers to withhold pain medication as opposed to treating pain prior to obtaining informed consent due to the concern of invalid informed consent. Pain’s influence on cognition can significantly impact the cognitive domains required to obtain valid informed consent. Determining if a patient has the capacity or competence to participate in the informed consent process has medical, ethical, and legal implications. The medical use of competence and capacity is not equivalent to the legal use of the same terminology. Legal implications concerning consent include signing consent while in duress or pain, signing under the influence of opioids, and determining if withholding treatment until consent is obtained may be considered coercion. While the legal system has the final say, the onus is with anesthesia providers to determine if the patient is able to participate in the informed consent process. Other factors that should be considered include the validity of obtaining consent from a chronic opioid user, who has taken medication on the day of surgery or on the day of the anesthesia screening. The complexities of anesthesia, along with the patient’s comorbidities also must be considered when evaluating a patient’s understanding of informed consent. Developing or incorporating a standard guideline during the anesthesia screening may be helpful in determining if a patient is cognitively able to participate in the consent process. Research suggests that optimizing pain relief can improve decision-making while obtaining consent.
Aja, Bryan, "The Effects Of Pain On Informed Consent" (2017). Nurse Anesthesia Student Capstones. 10.