Not just a separate consent for anesthesia!

A colleague recently commented about the practice of anesthesia consent in India: " In our country every institute has a separate consent for anesthesia. " Such a state of affairs is arguably desirable but not true. The practice of obtaining a specific consent for anesthesia separate from the consent for surgery (separate anesthesia consent) is not uniform across hospitals within this country or in others. The hospitals accredited by the National Accreditation Board for Hospitals and Healthcare Providers or those certified by the Joint Commission International, do use a separate anesthesia consent form. Most of the others probably do not. Even when a separate anesthesia consent is taken, it is mostly a mere signature on the form. Does it really constitute informed consent in the true sense? The essential components of informed consent are assessment of patient's capacity, disclosure of medical information, and voluntary consent/ approval by the patient. Obtaining consent, therefore, requires an unhurried two-way interaction between the anesthesiologist and the patient, with the latter provided with relevant details, and time to understand and ask questions. Only such a decision can be considered a true informed consent. The recently updated guidelines for consent for anesthesia by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommend that the information should be provided as early as possible and that it should be in the form of a resource (online or a printed leaflet) to which the patient can refer to for deliberation. This may not be practical in India at present but can be considered in the future. In a commentary on separate anesthesia consent published in this issue of the journal, Singh states that obtaining consent is an ethical responsibility of anesthesiologists toward their patients. It improves patients' satisfaction with the medical care and may even afford some legal protection to the anesthesiologists. The process of obtaining consent is also likely to enhance the status of anesthesiology. So why is this not a universal practice? A small survey of conference attendees in India found that though most felt the need for a separate anesthesia consent, only a few practiced it. This finding is probably generalizable. Why is that? What are the difficulties in obtaining a separate anesthesia consent? First and foremost, anesthesiologists see their patients only for a brief period during preoperative evaluation, while obtaining a proper consent requires more time. Besides the plan of anesthesia, the issues …