Informed consent
First off, we are not involved in this family situation as it’s long been made clear who’s in charge (we’re actually grateful it’s not us) MIL, many years of ignored hearing loss, always a bit flaky, is declining further and further into dementia. Whole family acknowledges both she and FIL have dementia, though hers is worse, but no medical evaluation or diagnosis will be sought. They eat meals on repeat as they can’t remember if they’ve eaten, buy the same groceries over as they can’t remember what they have, no longer remember to call anyone, don’t recall what they’re told at doctor appointments, and mostly just isolate (though the cars have not been taken, driving continues, yes stupidly) still live on their own. She’s going to have a significant heart surgery soon, cardiologist insists it’s needed. She can’t remember to do pacemaker checks and has no idea what’s being done. When she’s asked just says she will do whatever is needed. Hence my question/concern—for every medical procedure anyone in my family has had, right before the anesthesia, the questions are asked, tell us your name, birthdate, and what procedure you’re having today. This is after the pre surgery time when informed consent is obtained and signed by the patient. She is definitely not able to recall what the surgery is or why she’s having it. Is it still valid to say she’s consented? There will be no admission of dementia by family. What’s the medical staff’s role in assuring the patient has any clue what they are agreeing to? My son had a huge surgery within days of birth, I was in a complete fog and can guarantee there was no true “informed consent” by me. Yet I know it’s there, all signed. I guess I view this as a bit mean to MIL. She’s never made any effort to be close to me or the grandchildren I gave her, but I still don’t want to see her harmed by a surgery her muddled mind doesn’t understand. Not to mention anesthesia in her mid 80’s. Informed consent with dementia? Any thoughts?
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Here's some info:
This is exactly the kind of gray area hospitals and surgeons deal with every day in older adults — especially when families have adapted to a person’s decline for so long that nobody has formally labeled it.
Having dementia does not automatically mean someone cannot legally consent to surgery. Capacity is task-specific and situation-specific. A person can have memory loss, repeat questions, forget appointments later, even have moderate dementia, and still potentially demonstrate enough understanding in the moment to consent.
What clinicians are generally looking for is whether the person can, at least briefly understand the basic nature of the procedure, understand the risks/benefits in broad terms, communicate a choice, and show some appreciation of consequences. The bar is often lower than families expect. So if she says something like:
“They’re fixing my heart because without it I could get very sick,” that may be considered sufficient even if she forgets it 20 minutes later. Now, if she truly cannot explain what surgery is happening, understand why it’s needed, or demonstrate any meaningful comprehension, then the team may question capacity. At that point they might involve the anesthesiologist, consult the surgeon again, contact next of kin, or rely on a healthcare proxy/POA if one exists.
Here’s the important practical reality: hospitals are very accustomed to elderly patients with cognitive impairment. The pre-op “What surgery are you having today?” question is partly identity/safety verification, wrong-site prevention, and a quick cognitive screen. It is not usually a formal legal competency hearing. If her confusion is obvious, staff will notice. Especially anesthesia staff — they are often very attuned to dementia, delirium risk, inability to follow conversation, hearing impairment, and cognitive fluctuations.
One thing families often do not realize: you are allowed to tell the medical team your concerns privately. You do not need a formal dementia diagnosis to say, “We are very concerned she does not understand what is happening and may not remember conversations. ”That information is actually useful to anesthesia and surgical teams. You are not “getting her in trouble” or taking away her rights by communicating concerns.
If she clearly cannot demonstrate understanding on the day of surgery, the team generally will not simply ignore that. They may still proceed if there is a legally authorized surrogate and the surgery is medically necessary, but they usually will not pretend profound incapacity does not exist once it becomes obvious in front of them.
(Info aggregated by ChatGPT5.3)