The process of informed consent involves discussing the indications, risks, and benefits of treatment. Assessing a patient's understanding of the discussion and responding to specific concerns or confusion is essential to obtaining valid consent.

When a patient is unable to communicate his or her wishes regarding care and does not have an advance directive or designated surrogate decision-maker, decision-making falls to the next of kin (eg, spouse). The next of kin is generally determined by the proximity of relationship and is responsible for making decisions based on what they believe the patient would want and the patient's best interest.

The essential components of informed consent include explanation of the patient's diagnosis and proposed treatment, other treatment options, the risks and benefits of the proposed treatment, and the risks of refusing the proposed treatment.

Medical decision-making often involves balancing conflicting ethical principles (ie, autonomy, beneficence, nonmaleficence, justice). While recognizing patients' rights to make personal health care decisions (ie, autonomy), the provider has the responsibility to use specialized training to incorporate the best interests of the patient into the provision of care (ie, beneficence), which includes limiting nonindicated interventions.

Directive counseling is ethically appropriate when only one treatment option is medically reasonable and has clearly superior evidence-based support. Patients with complete placenta previa should be counseled that cesarean delivery is medically necessary.

When a patient is unable to give consent for care and does not have a designated surrogate, decision-making capacity falls to the next of kin, generally determined by the proximity of relationship. In an emergency, the physician can treat an incapacitated patient without obtaining consent.