Informed Consent: Capacity and Shared Decision-Making

Informed consent is both a legal doctrine and an ethical process central to NP practice. It reflects the bioethical principles of autonomy (respecting the patient's right to self-determination), beneficence (acting in the patient's best interest), nonmaleficence (do no harm), and justice (equitable access to information). The NP who prescribes medications, orders diagnostic tests, and performs procedures must understand the nuances of consent, capacity assessment, and shared decision-making at an advanced practice level. The legal evolution of informed consent moved from paternalistic 'doctor knows best' through the reasonable physician standard (what a reasonable physician would disclose) to the current reasonable patient standard (what a reasonable patient would want to know to make a decision). In most jurisdictions, material risks — those that a reasonable person in the patient's position would consider significant — must be disclosed, along with the nature and purpose of the proposed treatment, expected benefits, alternative treatments including doing nothing, and consequences of refusal. Capacity assessment is a clinical determination made by the treating clinician (not a legal determination of competence, which requires a court). Capacity has four...