Medical Consent and Intoxicated Patients

Re-upping this post because there’s been some discussion on the IAFN listserv about intoxication and it’s worth reminding people there’s no BAC at which a patient must be before they are able to ask for emergency medical care (which is generally what a sexual assault medical forensic exam is considered). The same standard required to sign papers for a mortgage, or buy a car, or have elective surgery, or drive a car, is not the standard by which someone should be assessed for being able to consent to a medical-forensic exam. Please do not take my word for it (I do not provide legal advice–this is not legal advice). Please consult your hospital attorneys, risk managers and other smart professionals who get paid big money to help you make these decisions. However, if you need some supplemental materials to help them with the task, may I suggest, after you review the SAFEta website, some of the following:

A guide to decision-making capacity (Jones & Holden, 2004)

Assessment of Patients’ Competence to Consent to Treatment (Appelbaum, 2007; FULL-TEXT)

Mental capacity, legal competence and consent to treatment (Buchanan, 2004; FULL-TEXT)

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations (Marco, et al., 2017)

Bonus for our readers in the UK, Consent to Treatment–adults who lack capacity (as part of BMA’s medical student ethics toolkit)

I hope people will consider moving away from strict quantitative determinations and employ a set of clinical assessment criteria that are more likely to be accurate across populations. I would also encourage you to consider what the existing standard is in your Emergency Department, including your Fast Track (or equivalent) and consider using those policies as a yardstick by which to measure the policy for your medical-forensic exam patients, depending on where those patients are also seen (so possibly different if outside your ED, maybe even more so if seen in a community-based clinic).

Again, not legal advice–simply food for thought based on my own clinical and professional experiences.

 

Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

 

Comments

  1. July 25, 2018 | 4:12 pm

    Rosalyn

    Thank you Jen for always pulling out the evidence sources that make me question and refine my views. This afternoon I am going to revise our policy ;’D

    • July 26, 2018 | 3:18 am

      Jen

      Rosalyn, you are neither the 1st nor the last clinician who has struggled to find a consistent way to address the question defense often poses: how is it possible this patient could consent to medical procedures when she couldn’t consent to sex? The answer is, it’s a different criterion by which we evaluate patients seeking medical help in an emergency situation. Glad this is helpful. Keep doing the excellent work you’ve been doing out there. Jen