N108: Transition to the Registered Professional Nurse Role Study Guide In situations where the patient does not have a legally designated guardian or substitute decision maker, the law in each state specifies who is allowed to give consent in such situations. Many states will allow the spouse, parent, children, or siblings to make decisions and give consent. The parent or legal guardian usually provides consent for care of a minor. The nurse should obtain the minor’s consent when he or she is able to give it. Many courts are emphasizing that minors be allowed to voice their consent when it concerns matters that they are capable of understanding, and this is especially true for adolescents. But this consideration should only be given to any child who is seven years of age or older. When minors refuse care and legal guardians have authorized that care, do not proceed until legal clarification is given. Often courts do not seek consent from minors, but rather an indication that they understood the purpose of the care. Minors who live apart from their parents and are financially independent, or who are married, are termed emancipated minors. In most (but not all) states, emancipated minors can give consent to their own treatment. Some states have specific laws relating to the mature minor, allowing sexually active minors to give personal consent (without also obtaining parental consent) for treatment of sexually transmitted diseases or for obtaining birth control information and supplies. Consent in an Emergency In emergencies, the standard procedures for obtaining consent may be impossible to follow and critical thinking on the part of all healthcare professionals is essential when differentiating an emergency from a nonemergency. Most facilities often require at least two physicians in the emergency department must examine the patient and concur that the emergency requires immediate action without waiting for consent. If a true emergency exists, consent for care is considered implied. This law holds that if a reasonable person were aware that the situation was life-threatening, he or she would give consent for care. Other terms pertaining to consent: • Withdrawing consent: A consent may be withdrawn after it is given. People have the right to change their minds. The nurse has an obligation to notify the physician if the patient refuses a medical treatment or procedure. Individuals participating in any type of research protocol for care are free to withdraw from the research study at any time • Patient records: These can be used in court. The records are owned by the practitioner or agency that created them; however, the patient has the right to obtain copies of their records. A patient’s legal surrogate also has the right to the records. • Incident reports: These are made to document information on errors and as part of quality improvement. They are not part of the patient record. • Advance directives : This is a legal document stating the wishes of individuals regarding healthcare in situations in which they are no longer capable of giving personal, informed consent. These documents are completed in advance of the situation in which they might be needed, and they direct the actions of others. Several types of advance directives, such as a living will and a durable power of attorney for healthcare, are used as evidence of the patient’s wishes for care if the patient becomes incompetent and/or terminal.