Ethical and High-Stakes Decision-Making

1. Can you touch this patient at all

Every call starts with one legal question. Can you touch this patient?
That's consent, and it comes in four flavors.

Expressed consent is verbal or non-verbal. The patient says yes, or the
patient holds out an arm for the IV. Implied consent covers the patient
who cannot say yes — unconscious, or too altered to understand you. The law
assumes a reasonable person would want help, so you're covered under the
emergency doctrine. Involuntary consent applies to mental health
holds and incarcerated patients, where someone else has already made the
call. And consent for minors runs through a parent or guardian. Or
someone standing in loco parentis — Latin for "in place of a parent." A
teacher on a field trip, a grandparent with custody, that role.

Some minors don't need a parent's consent at all. They're emancipated:
married, in the armed services, or independent by court decree. Treat them
like an adult.

Capacity is the piece that trips people up. It is not a status you have
or don't have. It's decision-specific and fluctuating. A patient with
mild dementia can still have capacity to refuse a blood pressure check. A
sharp, competent patient can lose capacity in minutes to hypoxia,
hypoglycemia, a head injury, or intoxication. So before you accept a
refusal, check a glucose and a saturation. That correctable cause of
impaired capacity is exactly what the exam builds its refusal items around.