Anesthesia personnel are most often seen in legal correspondence in connection with the informed consent process. Patients often come to the healthcare industry seeking care, and we can assume that they want the care they seek. This assumption is false if the patient believes that the care is sufficient and can be ended and chooses not to be treated. Essentially the process of informed consent represents the formation of a doctor-patient relationship. The patient seeks diagnosis and treatment; the physician makes the choice to diagnose and provide treatment. The patient may not force the physician to make a treatment that is contrary to his or her wishes, just as the physician may not force the patient to accept a treatment he or she does not want to receive. If consent is truthfully communicated, then full disclosure and understanding of the risks and benefits of treatment is a must. 1. Treatment In order to have informed consent, there must be an exchange of information. This requires the patient to have the ability to understand the nature of the treatment being discussed and the implication of accepting the treatment, and also the option of not accepting the treatment. It also requires the physician to disclose the potential benefits of the treatment and also the risks of accepting and not accepting the treatment. The extent to which risks are disclosed has been the subject of debate in recent years. The physician-based standard – which requires disclosure of risks that the physician considers appropriate – has largely been replaced by the “average normal person” standard. This standard requires that disclosure of risk is what an average normal person would consider when deciding whether to accept an offered treatment. It is important to consider the probability and severity of the risk. Death as an anesthetic risk is rarely likely to occur, yet it is so serious that it should be communicated. At the other extreme may be sore throat from tracheal intubation, probably because it occurs frequently enough that its disclosure is appropriate. The ordinary normal person standard is now widely accepted in most jurisdictions. 2. Blood products Although many standard surgical informed consent forms include provisions for the use of blood products, in some jurisdictions there is still a separate informed consent document associated with them. Part of the reason for this is due to its inherent risk – albeit small – of spreading infectious disease, as is allowing those who refuse to use blood products for religious reasons to participate in meaningful informed consent conversations. Refusal to use blood products, a situation often encountered when Jehovah’s Witnesses receive anesthesia and surgery, can raise ethical conflicts for physicians. Although infrequent, being asked to comply (with informed consent) while allowing a patient to face death because of an inability to transfuse blood can raise conscientious objections on the part of the health care provider involved.36 Yet we would do well to recognize that patients do have the right to refuse treatment, even if it is necessary to sustain life. 3. Emergencies There are exceptions to the duty of disclosure. The legal system recognizes the right of a physician to take action without the patient’s consent in a true emergency, as long as his or her actions are consistent with routine behavior in exceptional emergencies. The presumption of consent exists in emergency situations, where the patient wants life-saving treatment. Rarely is there a situation in which a minimal discussion of the risks of treatment could be harmful to the patient. When the discussion of risks causes emotional distress, such as stopping a reasonable discussion, the physician may exercise medical privilege and inform the patient of the full discussion of risks. In this situation, it is proper to document in detail and discuss the situation with family members. 4. Delegated Consent If the patient requiring surgery and anesthesia is incapacitated, there will generally be a family member in charge, and the family member can participate in informed consent. This long-standing situation is permitted by law and is based on the assumption that family members are generally concerned about the patient’s interests and are usually best informed about the patient’s choices, goals and values. Many states have had family informed consent statutes in place since the 1980s that spell out the hierarchy of family members and close friends who are likely to make medical decisions. Generally spouses, parents, legally available adult children and closest living relatives are ranked in descending order. Some states have separate statutes, but still incorporate these statutes regarding living wills, advance directives and health care decisions into their own state statutes.