patient-physician-relationship-topics/informed-consent.page (Last accessed July 26, 2011.) 2. American Medical Association: AMA Position on Provision of Life-Sustaining Medical Treatment. www.ama-assn.org/ ama/pub/physician-resources/medical-ethics/about-ethics- group/ethics-resource-center/end-of-life-care/ama-policy- provision-life-sustaining-medical.shtml (Last accessed July 26, 2011.) 3. Meisel A, Kuczewski M: Legal and ethical myths about in- formed consent. Arch Int Med 1996;156:2521–2526. 4. Weissman DE: Decision making at a time of crisis near the end of life. JAMA 2004;292:1738–1743. Address correspondence to: David E. Weissman, M.D. Division of Hematology and Oncology Medical College of Wisconsin 9200 W. Wisconsin Avenue Milwaukee, WI 53226 E-mail: dweissma@mcw.edu DOI: 10.1089/jpm.2011.9651 Informed Consent in Palliative Care: Part II #165 David E. Weissman, M.D. and Arthur Derse, M.D., J.D. Background I n Fast Fact #164, the legal basis for the informed con- sent process was reviewed; this Fast Fact discusses common myths about informed consent that arise in palliative care. Readers wishing more information should read the excellent review by Meisel and Kuczewski. Myths 1. Use of Signed Consent Forms—Myth: Federal or state laws require written informed consent (patient signature) for invasive procedures. FALSE: Signed consent forms are used per local hospital or institutional or accrediting organi- zation policies. They are generally not mandated by law or federal/state regulation. Note: State law may mandate written consent for certain tests or high-risk treatment (e.g., HIV or genetic testing, or electroconvulsive therapy) and federal law may require written consent in some circumstances (e.g., transfers from emergency depart- ments). Signed consent forms may not shield the physi- cian from claims of negligence due to failure to provide informed consent if the physician did not fulfill the in- formed consent process (see Fast Fact #164). 2. Emergency Transport to a Medical Facility—Myth: No informed consent is necessary for patients admitted to a hospital in transfer from a nursing home, or for patients transported to the hospital following a 911 call. FALSE: There is no ‘‘implied consent’’ just because 911 or a transport ambulance was called; such patients require the same level of informed consent discussions for medical care decisions as any other patient, unless the medical situation satisfies the criteria for the emergency exception (see Fast Fact #164). 3. Low-risk Treatments—Myth: No informed consent is nec- essary when starting ‘‘low-risk’’ life sustaining treatments such as intravenous (IV) antibiotics, IV hydration, feeding-tube placement, or blood products. FALSE: All these treatments represent interventions with risks and alternatives. An informed consent discussion is especially necessary in seriously ill or dying patients where the option of no intervention is a reasonable choice; the failure to discuss not using life-sustaining intervention represents a failure to pro- vide full informed consent. Also, patients should be in- formed that if a life-sustaining treatment becomes too burdensome (a risk of any treatment), the patient may withdraw his or her consent and the treatment will be stopped. 4. Present Options But Not a Recommendation—Myth: Informed consent means that patients should choose among medical options without physicians introducing their bias toward one specific option. FALSE: The physician’s obligation is to present medical information accurately to the patient or to the individual responsible for the patient’s care and to make recommendations for management in accordance with good medical prac- tice. The physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives. 5. Documentation—Myth: An informed consent discussion needs no special documentation except in cases of invasive procedures. FALSE: Even if not legally required, the content and outcome of an informed consent discus- sion should always be documented in the medical record and include the elements noted in Fast Fact #164 as an indication that the ethical and legal re- quirements of the process of informed consent have been fulfilled. 1066 FAST FACTS AND CONCEPTS