In Reply:—
We appreciate the comments made by Dr. Herbert regarding the importance of disclosure in informed consent and the documentation thereof in the medical record. Dr. Herbert cites our study regarding anesthesia for the child with an upper respiratory tract infection 1as a good example of the importance of fully discussing the elements of consent (i.e. , risks, benefits, procedures, and alternatives) with the patient, his or her surrogate, or both. The importance of informed consent as a process has been highlighted in some of our research. Recently, we presented an abstract at the annual meeting of the American Society of Anesthesiologists that examined parental understanding of informed consent for pediatric anesthesia research. 2Results of this study showed that only 61.7% of parents had complete understanding of the risks of the study, 55.8% had complete understanding of the benefits, 54.8% completely understood the protocol, and 82.8% understood the alternatives. Although our study addressed understanding of consent for research, the elements and the requirements for disclosure are essentially the same as those required for anesthesia and surgery. Clearly, consent for anesthesia (and anesthesia-related research) offers a unique perspective given that consent may be sought just before surgery, in a less than private setting, and at a time when the patient (or subject) is most anxious. Therefore, as Dr. Herbert suggests, it is critical from both an ethical and a legal perspective for the physician to discuss the elements of informed consent frankly with the patient or surrogate, to ensure that they fully understand the information, and to provide documentation that the elements of consent have been discussed.
