The morality of obtaining blanket consent for invasive procedures in the intensive care unit

Ramkillawan, Arisha
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The Intensive Care Unit (ICU) in hospitals is an unfamiliar environment for patients and their families. By virtue of their illness, ICU patients require multiple invasive procedures for diagnostic and therapeutic purposes. These procedures are not without minimal risk – hence informed consent is important. Current practices in obtaining informed consent occur in a variable, inconsistent manner. This normative report explores the morality of obtaining blanket consent for invasive procedures in the ICU upon, or just prior to, admission to the ICU to assist with some of the challenges. Using deontology and the ethics of care as argumentative strategies, I argue in favour of the moral permissibility of obtaining blanket consent for invasive procedures in the ICU. To achieve this, a library and web-based search of the current literature pertaining to obtaining informed consent in the critically ill was done as well as the ethical literature supporting informed consent. Written from a South African perspective, my argument rests on using respect for individual autonomy, as well as care ethics’ view of relational autonomy, to show that blanket consent obtained from the patient or their designated proxy for invasive procedures in the ICU can be morally permissible. I also argued in favour of a soft paternalistic role of the clinician, who needs to be trustworthy to safeguard and protect the patient from potential exploitation or unnecessary harm. In this way, I show how these two dichotomously opposed concepts, autonomy and paternalism, can co-exist and assist in justifying a blanket consent policy for critically ill individuals in an ICU. Lastly, following the acknowledgment of the report’s limitations, I suggest areas of future research and potential reform to enable the utility of blanket consent in clinical practice for critically ill patients.
A research report submitted in fulfilment of the requirements for the degree of Master of Science in Medicine (Bioethics and Health Law) to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2022