Achieving informed consent when patients appear to lack capacity and surrogates

Obtaining informed consent is a frequent and important part of the practice of orthopaedic surgery. However, the process can be complicated, especiall y when there are impediments to communication and unusual decisions. An app roach that considers each of the elements of informed consent permits the c linician to enhance the role of autonomy in patient decisions while maximiz ing the probability of achieving successful informed consent. Attending to land testing when necessary) a patient's capacity to make decisions, ensuri ng comprehension of the clinical circumstances and proposed intervention an d it's risks and benefits, and evaluating the decision-making mechanism are essential steps. A patient's capacity to participate in informed consent a t times may be enhanced by selected interventions and may require serial re evaluation to identify the optimal time to discuss the issues,Implied conse nt has an important but delimited role in emergent circumstances, Prospecti ve elicitation of patient preferences and delineation of surrogate decision makers can substantially enhance the ease and efficiency of informed conse nt while matching care with patient goals.