Ethics, communication and palliative care

Consent, capacity, documentation and medico-legal practice

Reviewed Nov 2026·3 references
New· views rounded down, updated weekly

Informed consent in ICU, capacity and surrogate decisions, medico-legal cases, records, and LAMA/DAMA discharge.

Definition
Good ICU documentation records what was found, what was decided, why, and who was informed. Indian regulations require indoor records to be kept for at least 3 years and provided to the patient or authorised representative within 72 h of a request.

At the bedside

  1. 1

    Consent

    Informed consent for procedures and high-risk treatment: nature, benefits, risks, alternatives, in the patient's language; emergency treatment can proceed without consent when delay would endanger life (document why).

  2. 2

    Capacity

    Assess decision-specific capacity (understand, retain, weigh, communicate); if absent, involve the legally appropriate surrogate and act in the patient's best interests.

  3. 3

    Daily notes

    Time-stamped entries with problems, plan, discussions with family (who, what was said), and consultant review.

  4. 4

    Medico-legal cases

    Trauma, poisoning, burns, assault, suspicious deaths: register as MLC, inform police, preserve samples (gastric lavage, blood, clothing) with chain of custody.

  5. 5

    LAMA/DAMA

    Explain risks, offer alternatives, document capacity, the information given and signatures of patient/relative and witness; give a discharge summary.

  6. 6

    Records access

    ≤ 72 h

    Provide copies within 72 h when requested by patient or authorised representative; maintain confidentiality.

Red flag · call your senior now
Altering or adding to notes after an adverse event without dating them as late entries - unethical and legally damaging.
Pitfall
Consent forms signed without a documented discussion.
Pitfall
Not documenting family meetings and limitation decisions.
Pearl
Document the reasoning ('because...') behind major decisions; it protects the patient's interests and the team.

References

  1. 1

    Medical Council of India. Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 (as amended). Reproduced in Indian Journal of Medical Ethics.

  2. 2

    Chawla R, Kapadia F, Rajagopalan S, Amin P, et al. Guidelines for end-of-life and palliative care in Indian intensive care units: ISCCM consensus ethical position statement. Indian J Crit Care Med 2012;16:166-81.

  3. 3

    Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 2017;45:103-28.

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