Guiding light at the end of the tunnel
The most important issue here is obtaining informed consent for any procedure. Informed consent should be patient- and procedure-specific; otherwise there is a gap between what has been explained to the patient and what s/he has understood. A mere signature does not signify full comprehension. The process of informed consent must be one in which the patient and the relatives are taken into confidence and the risks involved in the procedure are explained to them. The process should envisage acute events that might occur and their subsequent treatment. The occurrence of a cardiac arrest was obviously not anticipated in this case, and because it was sudden, resuscitative efforts were attempted without having the time to take the relatives’ consent. As the authors themselves state, “…the absence of high-risk consent and preliminary discussion before the procedure increases the gravity of the event and poses a major dilemma regarding resuscitation. The medicolegal implications of such an omission can be severe and this incident emphasises the point.”
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