Informed Consent Challenges in Frail Surgical Patients

The principle of informed consent is one of the most controversial aspects of clinical bioethics and the core of contemporary patient-centered healthcare, embodying the values of autonomy or self-determination, freedom, and respect for human life, dignity, and the rights of the patient. The acquisition of consent or dissent is an act of speci!c and exclusive competence of every physician, not delegable to anybody. The physician does not undertake or continue in diagnostic procedures and/or therapeutic interventions without the preliminary acquisition of informed consent or in the presence of an informed dissent. The physician is recommended to acquire the consent or dissent of the patient in written form and signed or with other methods of equal effectiveness in documents. For frail surgical patients, ethical and legal issues are mainly related to the increased vulnerability to adverse outcomes when exposed to endogenous and/or exogenous stressors. Surgical interventions can represent a real challenge for all frail patients who may experience risks of falls, hospitalization, physical disability, and early mortality. The poor outcomes in frail surgical patients are often the object of medical malpractice claims, mainly due to poor information or an inappropriate pre-operative frailty assessment. To ensure that these individuals possess a comprehensive understanding of the potential bene!ts, risks, and alternatives, complete information should be addressed comprehensively and ef!ciently, with patients encouraged to actively participate in their care whenever possible. This chapter regards the importance of informed consent within the context of frail surgical patients, emphasizing the need for healthcare professionals to navigate the intricate complexities and considerations associated with respecting autonomy, protecting vulnerability, and promoting wellness.