Look here is good advice
The issue of informed consent is of great concern in emergency care. Several ethical and legal principles define the parameters of informed consent. The concept of autonomy provides the basis for informed consent as well as the basis for refusal of medical treatment. Although autonomy is an ethical concept, it also is one of the foundations of various legal principles including self-governance, liberty, rights, privacy, and individual choice.
US Supreme Court Justice Benjamin Cardozo stated, "Every human being of adult years and sound mind has a right to determine what shall be done with his own body." The physician-patient relationship is a dynamic interaction. Traditionally, physicians paternalistically administered those treatments they considered best for patients. Historically, a patient could consent to treatment simply by lack of objections. The current interpretation of consent has evolved to require a more active role on behalf of the patient. The physician must disclose risks, benefits, and alternative treatments to the patient. Informed consent requires a competent patient who makes a voluntary decision based upon adequate information.
To obtain consent, the patient must be clinically and legally competent. In most states, the legal age of consent for medical treatment is 18 years. Parents or legal guardians normally are required to consent for the medical treatment of minors, although a few exceptions exist as follows:
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to provide an adequate medical screening examination to anyone (including minors) who presents to the ED, even if appropriate consent cannot be obtained. If no immediately life-threatening condition is identified, institute procedures to obtain consent for treatment. In many states, marriage or pregnancy often confers an emancipated status to minors, who then can consent to procedures and treatments. In the interest of a greater societal good, various conditions exist (depending upon the state) for which minors can consent to treatment. These conditions include treatment for (1) sexually transmitted diseases, (2) alcohol or drug abuse, (3) domestic or sexual abuse, and (4) mental health issues.
Minor parents of children also can consent to treatment for their children and themselves. Additionally, mature minors (ie, close to age of maturity) can consent, at times, to less invasive or less risky procedures if the physician feels the patient understands the concepts of consent.
Clinical competency can be defined as the ability to comprehend and rationally act upon information provided by a healthcare professional. Intoxication and active psychosis affect an individual's ability to give adequate consent. Carefully examine the patient's mental status and reasoning ability when trying to obtain consent. Furthermore, common law or other statutes may govern which patients can consent legally.
In addition to determining the patient's competency to consent to medical treatment, the physician must impart the appropriate information to obtain consent. In some states, the standard of disclosure is defined as what a reasonable physician in a similar situation would disclose; other states require disclosure of the risks and alternative treatment options that a reasonable patient would want to know before consenting to a proposed therapy. In some circumstances, physicians may invoke therapeutic privilege and do not have to disclose extremely rare risks or complications that, if disclosed to the patient, may unreasonably prejudice the patient's decision.
Distinctions are made among various types of consent.
General consent
When patients present to the ED, they typically sign a general consent during the registration process. General consent indicates that the patients are willing to undergo basic evaluation and treatment. Controversy exists regarding the definition of basic treatment. Few argue that taking vital signs or performing a routine physical examination requires the physician to obtain further consent from the patient.
Nonemergent specific consent
Obtain a more nonemergent specific consent for procedures and treatments that may be more invasive (eg, chest tube placement), have more risks (eg, conscious sedation vs general anesthesia), or may be considered experimental. Ideally, physician-patient discussion should be witnessed and written documentation of consent obtained. Discussion should include the following:
Specifics of the procedure (ie, why it is being performed, how it is performed)
Risks and benefits
Any alternative treatments
Emergency consent
In an emergency, attempt to obtain informed consent from the patient or from an appropriate surrogate decision maker. In certain situations, emergency consent is implied. In these instances, normal consent standards are not followed because immediate treatment may be required even before an opportunity to obtain consent is available. The assumption is made that the average, reasonable, competent patient would agree to standard treatment in an emergency if able to consent. An example of such a situation is a patient who suffered a pneumothorax and, as a result of decompensating vital signs, is unresponsive and unable to give consent. In the best interest of the patient, the physician should proceed with a tube thoracostomy rather than try to obtain consent.
Caveat to consent issues
Emergency or implied consent cannot always be applied simply because a patient presents to the ED. If a patient's condition is not immediately life threatening, consent must be obtained from the patient or the appropriate surrogate. For example, a patient who presents to the ED with an acute-onset headache and requires a workup for a possible subarachnoid hemorrhage does not automatically consent to a lumbar puncture simply because she or he is in the ED. If the patient is of sound mind and judgment and refuses to consent to the procedure, the physician cannot apply emergency consent and may not proceed.
The US Supreme Court has recognized that a "person has a constitutionally protected liberty interest in refusing unwanted medical treatment" even if refusal could result in death. The prudent physician tries to explore the reasons for refusing therapy. If the patient continues to decline treatment, document this discussion and refusal. This can be done on a "discharge against medical advice" form.
Although courts protect a patient's rights to refuse care, "preservation of life, prevention of suicide, maintenance of the ethical integrity of the medical profession, and protection of innocent third parties" also may be considered when evaluating a patient's wish to refuse treatment. Each case must be examined individually.
In discussions concerning the refusal of appropriate treatment, inform the patient of possible adverse outcomes resulting from inadequate treatment. Provide information regarding available treatment even to patients with terminal diseases who have advanced directives. Patients frequently reconsider treatment when informed of the possibility of disability or death. Additionally, patients often refuse to consent simply because they do not understand the proposed therapy completely. Encourage patients who refuse care to return should they change their minds.
If a parent's refusal of treatment seriously jeopardizes a child's well-being, physicians may consider taking temporary protective custody under child abuse laws, which vary from state to state. In general, parents cannot refuse life-saving therapy on religious or other grounds. Courts previously have decided in favor of the physician treating the minor. Time permitting, whenever needed medical care for a minor is refused, the responsible provider and institution should seek assistance from appropriate court authorities and ethics committees.
In providing medical care, the universal goal is to act in the best interest of the patient. A patient's best interest may be served by providing leading-edge medical treatment, or it may be served simply by honoring a patient's refusal of care. This goal is based on the principle of autonomy, which allows patients to decide what is best for them. Although complicated issues can arise when physicians and patients disagree, the best policy is to provide adequate information to the patient, allow time for ample discussion, and document the medical record meticulously.
In your case, if there was no emergency, a lumbar puncture requires a consent. So does a Foley Cathter, because they are both Invasive. So I would contact an attorney.