Informed Consent in Case of Sundowners Syndrome
The main elements of informed consent could be seen in that the concerned patient should be fully aware and involved in treatment and procedures that are being carried out on them. Further, it is also necessary that patients need to be informed and appraised about the medical treatment meted out to them and should be given opportunities to decide for themselves whether to accept or decline such interventional methods.
Even life-threatening medical care could be refused by patients of their choice. If this is not practicable, since the patient may be in an unconscious state or not able to reach any rational decision, the authority for informed consent will vest on a “surrogate decision-maker,” and they would be responsible for providing informed consent. In this case, it is seen that the 86-year-old lady had undergone hip replacement intervention. It is seen that informed consent would have been taken, either through the patient herself or through her daughter, a proxy decision-maker.
The symptoms of sundowners symptoms need to be specifically treated, if necessary, with psychiatric evaluation, treatment, and interventions.
In this case, the fact that informed consent could be obtained could be seen by examining hospital medical records and audit trails of the patient’s case history. It can also be seen in terms of the fact that the intervening surgery could not have taken place without obtaining the necessary permission from the patient or from surrogate responsible persons. However, this may not be possible during an emergency when a life-or-death situation occurs, and the patient is neither in a position to give informed consent nor responsible persons are available to provide the same. In such a case, the concept of best judgment, keeping the critical aspects of the case, has to be made by the doctors in consultations with nurses and other health care professionals.