Exceptions to Informed Consent
Following legal developments in the United States, there are certain well-recognized types of situations where informed consent need not be solicited from the patient. The exception based on the incompetence of the patient has already been discussed in the previous chapter. Aside from patient incompetence, there are three other legally sanctioned types of exceptions: (1) in an emergency, when there is insufficient time to pursue an informed consent, at least if one is to avoid significant morbidity and mortality to the patient in the interim; (2) when a competent patient waives the right to an informed consent and consents to what the physician wants to do without further information; and (3) when the physician claims the therapeutic privilege not to inform the patient on the ground that the informing process itself would likely harm the patient in an unacceptable way. We will deal with each of these possible exceptions in this chapter, being particularly concerned to state their sense and justifying conditions as specifically as possible, lest such exceptions come to undermine the rule of gaining informed consent.
In general, the emergency exception may be stated as follows: "If informed consent is suspended in an emergency, it should be because the time it would take to make disclosure and obtain patients' decisions would work to the disadvantage of some compelling interest of patients" (Appelbaum, 1987, p. 68). Specifically, an emergency situation that would legitimately justify withholding the attempt to gain an informed consent would involve the following factors: (1) there must be a clear, immediate, and serious threat to life and limb; (2) the