Journal of Clinical Research & Bioethics

An Informed Consent: A Little Life at Risk

Afsana Padaniya^* School of Nursing, Aga Khan University, Karachi, Pakistan
^*Correspondence: Afsana Padaniya, School of Nursing, Aga Khan University, Karachi, Pakistan, Email:

Received: 07-Jul-2022, Manuscript No. JCRB-22-17351; Editor assigned: 11-Jul-2022, Pre QC No. JCRB-22-17351(PQ); Reviewed: 01-Aug-2022, QC No. JCRB-22-17351; Revised: 11-Aug-2022, Manuscript No. JCRB-22-17351(R); Published: 19-Aug-2022, DOI: 10.35248/2155-9627.22.13.425

Introduction

A preterm 33 weeks, 1.6 kg weight was presented in Neonatal Intensive Care Unit (NICU) from Labor Room with complain of respiratory distress and tachypnea having 68 breaths per minute. He was initially kept on nasal CPAP to reduce the distress. After few hours, patient desaturated to SpO₂ 47% and heart rate 69 beats per minute. Bagging was done and the patient was immediately intubated and kept on mechanical ventilator support. Along with this, Umbilical Catheterization was also done for invasive blood pressure monitoring, blood samples and IV infusions. Patient’s father was called several times since patient’s admission for taking prior NICU consent and history but his phone was unreachable and mother was also in labor room, and no other family member was present outside NICU for any emergency contact, therefore patient was intubated and umbilical catheterization was performed without taking parent’s consent.

Ethical Dilemma

A new born infant, or neonate, is a child under 28 days of age. During these first 28 days of life, the child is at highest risk of dying [1]. Reflecting upon the scenario, neonates are very vulnerable population and their decisions are taken by their parents or guardians. This event raised many questions in my mind that although consent is very important to take before any procedure, but what if waiting for consent can risk the patient’s life? Do health care providers have authority to take decision in the absence of patient’s parents? Does parental autonomy hinder in the treatment and override beneficence? Above all, how deontological views override the importance of informed consent?

Position of a Health Care Professional

In health care settings, consent is taken at the time of admission of the patient, but in any emergency situation in which patient’s life is at risk, health care professionals are obliged to perform their duty and benefit patient by saving patient’s life. “Beneficence is a statement of moral obligation to act for the benefit of others”. By analyzing the above mentioned definition, saving a patient’s life or doing something for the benefit of patient is an obligatory right of a health care professional. Furthermore, it is not always necessary that action is right, action may be wrong regardless of good consequence. But deontology only focusses on the outcome [2]. Ventilating a patient without taking consent may present as a bad action, but the survival of the patient is a good outcome that deontology focusses on. In addition, code of ethics also says that neonatal nurses should always ensure patient’s safety and take actions that provide benefit to the patient [3].

Controversy

Parents of a new born child are the decision makers who have all the rights of taking decision for their child and it is a health care professional’s responsibility to ask parents before performing any procedure on the patient and take their consent by which parents allow health care team to perform any particular procedure on the patient. Informed consent is “a process by which patients are informed of the possible outcomes, alternatives, risk of treatments and required to give their consent freely. It implies legal protection of a patient’s right to personal autonomy by providing the opportunity to choose a course of action regarding plan of health care, including right to refuse medical recommendation and to choose from available therapeutic alternatives” [4].

Justification as a Health Care Professional

The patient’s father was not present outside NICU for giving antenatal history and signing the consent form and not even receiving the call. The mother of the patient had Cesarean Section and was still in labor room and was already in stress that her child is admitted to NICU and therefore it was not possible to take consent from the mother in the labor room in such stressful situation. However, patient’s life was at risk and no other family member was even present to take decision, the health care professionals intubated the patient to save patient’s life and also performed umbilical catheterization for blood sample, infusions and medications as well as arterial blood pressure monitoring to prevent patient from multiple intravenous pricks.

Conclusion

In conclusion, neonates are very vulnerable population and are dependent upon someone to take care of them. In such cases, parental consent is very important because parents are prime responsible to take care of their newborn and take decisions for their better health. But, in the absence of parents, health care professionals are responsible for patient’s health and they must do everything to benefit patient and save patient’s life. However, in the absence of parents, next of kin must be there to take decision for patient and if no one is available, health care professionals should have authority to take decision for the benefit of patient.

REFERENCES

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