(p. 107) Medico-legal and ethical issues 

The doctrine of informed consent is an important concept in medical care, but presents challenges in the critical care setting, where patients may have diminished capacity to provide their own informed consent. The elements of informed consent include adequate disclosure of information, cognitive capacity of individuals to make decisions, and the voluntary nature of such decisions. Currently, there are no universally accepted procedures regarding capacity assessment, especially in critically-ill patients. Such assessments remain subjective, but this chapter provides some guidelines on the subjective assessment of such capacity. When it is determined that patient lacks decision making capacity to provide consent, several mechanisms exist by which their autonomy can still be respected, including following any existing advance directives or family members or friends’ moral authority to make decisions for patients, based on either the substituted standard or the best-interests standard. Informed consent issues in the emergency clinical situations and in the context of research are also discussed.