The consent to the procedure or the lack thereof is a fundamental right of the patient. Unfortunately, sometimes a refusal to undergo a life-saving medical procedure can be tragic. When the sick person dies, questions arise …

Refusal to consent to a life-saving procedureis a patient's right, but often puts the doctor in a dramatic situation.

The patient has the full right to decide about his own he alth. The doctor is obliged to provide him with reliable information about the possible consequences of omitting the procedure and about the risks associated with its performance.

The law says that without the patient's formal consent, a doctor may provide him with medical help, subject him to tests only when he or she requires immediate assistance due to his he alth condition, and due to e.g. loss of consciousness, he cannot consent to such an intervention. Is this a good recipe? - we ask prof. Romuald Dębski.

  • When the patient refuses to sign the consent, there is nothing the doctor can do?

Prof. Romuald Dębski: In such a situation our hands are tied. Everyone has the right to decide about their he alth and life.

  • But there are legal provisions regarding consent to the procedure?

R.D .: The regulations are very imprecise. They do not regulate anything unequivocally. Currently, each hospital, each department prepares its own forms for patients. This is because there is no one, really good and universal document of consent to a procedure or surgery. In my opinion, legal harmonization in this matter is currently not possible. In addition, to put it bluntly - consent to an operation or a medical procedure is only a protection for the doctor.

  • What do you do when the patient does not want to sign the consent for surgery?

R.D .: Nothing. As long as the patient is conscious, he is not incapacitated, if he has the ability to make decisions about himself, he does not have to agree to treatment. And no one can make him change his mind. Of course, it is a bit different when he is unconscious or mentally ill. Then we have different procedures.

  • When the patient does not consent, do you try to convince him or her?

    • R.D .: It is my duty to explain exactly what will happen to the patientcannon, if the procedure is not performed. I am also talking about the risks associated with the procedure, but it is only the patient who decides whether they want to take them.

  • What if the reason for refusing is faith, such as Jehovah's Witnesses who refuse a blood transfusion?

    • R.D .: If a sick person does not want to have blood transfused, I have no right to do it. If he wants to remain faithful to his principles, I must respect that. But I can offer you an antihaemorrhagic or blood substitute which is accepted by the followers of this faith.

  • Is it morally difficult for a doctor to accept?

    • R.D .: Of course, but let me say it again - everyone decides for themselves. There are also situations when the operation is abandoned because it is known that the patient will not survive it. Every day we make difficult moral decisions. Going forward, if in difficult situations the patient does not agree to the procedure, it is better for the doctor. Then the patient takes responsibility for what will happen to him next. I have to respect his decision. If I have informed the sick person honestly and in plain language about all the consequences of the refusal, I can have a clear conscience. There were compensation cases, the basis of which was insufficient informing the patient about the consequences of the refusal to perform the procedure. Therefore, the form of informed consent also includes a refusal to perform the procedure. Such a refusal should be confirmed by the patient with his / her signature. What's more, the signature confirms the fact that he had the opportunity to ask questions, that he understood the answers, that he was informed about possible complications and consequences of the refusal.

  • There is a different form in gynecology for a woman who will have a caesarean section and another for a woman who will have a laparoscopically removed uterine polyp. Why is that?

    • R.D .: Because each of these activities carries different threats. Doctors who perform such procedures want to feel safe. Anesthesiologists also have separate forms, because general anesthesia carries different risks than conduction anesthesia. There are situations that for each, even the smallest, medical procedure, such as venipuncture, the patient has to give his consent and sign it.

  • Why is this happening?

    • R.D .: There are many reasons. First of all, each patient seems to know a little about medicine. The second reason is an avalanche of lawsuits for damages. Another - the media image of the Polish he alth service. So the doctors became very careful, they don't want to risk any more for the good of the patient. And so we run betweenthe oath of Hippocrates and reality.

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