Informed consent is a legal doctrine that has been developed by the courts over a number of years. The doctrine of informed consent may have been derived from the Nuremberg Code, which required that doctors obtain the voluntary informed consent of the subject prior to conducting medical experimentation. The Informed Consent Doctrine requires that medical doctors provide a patient with all relevant information about a proposed procedure or treatment prior to obtaining the consent of the patient to carry out the procedure or treatment. Four items of information that must be provided are:
Informed consent protects the patient by providing him/her with complete information on which to make an informed decision. Informed consent usually also protects the doctor from financial liability (with exceptions) provided that the procedure is properly executed according to the prevailing standard of care and without negligence. The adult patient's power to consent is very broad and includes the power to consent to such extreme operations as sexual reassignment. Inadequate provision of information, however, may invalidate the consent.
Informed consent in pediatrics
When the patient is incompetent as in the case of a child or an incompetent adult, a parent or other guardian usually gives surrogate consent. Parents are expected to exercise their power to consent only in the best interests of the child. Courts have narrowed the powers of consent by proxies. Proxies usually may only consent to procedures which are beneficial to the patient. An infant can neither be informed nor give consent for surgery, such as circumcision. This raises a serious ethical and legal question for physicians and parents.
The American Academy of Pediatrics issued an official policy statement regarding informed consent in pediatric practice in 1995 [Pediatrics 1995;95:314-317]. A number of statements in this report are relevant to circumcision, such as the following:
Permission of elective non-therapeutic neonatal circumcision
Infant circumcision has been designated as an elective procedure by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. This means it is not required for good health and it is not a recognized part of any hospital routine. The American Medical Association has defined neonatal circumcision as a nontherapeutic procedure. Some legal commentators believe that parents do not have the power to grant proxy consent to elective neonatal non-therapeutic circumcision. This concept, however, has not yet been tested in court.
The complete report is reproduced here.
See also Consent for a Medically Necessary Circumcision (Offsite link)
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