LessonsManagement of Care

Consent, capacity and client rights

Say who explains a procedure, what the nurse's signature attests to, when an advance directive takes effect, and whose decision counts when people disagree.

Who explains, and what the nurse signs

The person performing a procedure is responsible for explaining it: what it is, what it is for, what could go wrong, what the alternatives are, and what happens if it is not done. That duty cannot be handed to the nurse.

What the nurse's signature attests to is narrower and worth being precise about: that the person signing is who they say they are, that they signed voluntarily, and that they appear to have capacity. It does not attest that they understood the explanation.

A client who cannot say what is about to be done has not been informed. The correct action is to stop and call the person who is doing the procedure back — not to explain it yourself, and not to witness the signature and mention it later.

Capacity decides whose choice counts

A client with capacity may refuse anything, including treatment that would save their life, and may do so for reasons that nobody else finds persuasive. Capacity, not agreement, is the test.

  • An advance directive takes effect only when the client can no longer decide, and it can be revoked by the client at any time, including verbally.
  • A named health care agent speaks from the moment capacity is lost, and not before.
  • A family member's disagreement does not displace a conscious client's own stated wish.
  • Someone who merely brought the client in has no standing to consent to anything.

In an emergency, when the client cannot consent and nobody who may speak for them is present, consent is implied for treatment needed to prevent death or serious harm — and only for that.

Interpreters

Consent depends on understanding, so a client who does not share a language with the clinician needs a professional interpreter. A family member may translate accurately and still be the wrong choice: they have their own view about the treatment, and accuracy is only half of what impartiality provides.

Worth remembering

  • The person doing the procedure explains it; the nurse witnesses identity, voluntariness and apparent capacity.
  • An advance directive starts when capacity ends, and the client may revoke it at any time.
  • A conscious client with capacity outranks every family member's opinion.
  • Use a professional interpreter for consent, not a relative.
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