At law, all individuals are presumed to have the legal capacity to provide consent or refusal of treatment unless there are clinical indications of cognitive impairment. Once concerns are raised regarding the ability of an individual to provide valid consent for a surgical procedure, the use of a substitute decision-maker may be necessary. In this paper, we present an analysis of a clinical case study to illustrate the principles of valid consent. As part of the analysis, we discuss the issues relating to obtaining valid consent for an operative surgical procedure from an elderly client with obvious cognitive impairment. We also explore the role of a substitute decision-maker to obtain the requisite valid consent.

The legal doctrine of informed consent is the basis for ethical surgical treatment. It acknowledges that patients are autonomous, with the basic human right to make decisions regarding the treatment they receive.

In this paper we highlight the explicit role of informed consent and the use of a substitute decision-maker for individuals with impaired legal capacity using a case study involving an elderly couple who both have impaired cognition. In this case study, Elsie requires surgical repair of a fractured humerus but is unable to provide informed consent due to decreased cognition. Her husband, Bert, also has impaired cognition and the nursing staff must seek a substitute decision-maker to provide an informed consent for Elsie.