▸ Waiver or risks known to the patient: Some patients expressly indicate that they do not wish to be informed of the treatment procedure and associated risks. This constitutes a waiver and is recognized as a legitimate exception. Waivers should be documented in writing. The health care provider is also not obligated to disclose risks that are commonly understood, obvious, or already known to the patient.
▸ Informed consent not feasible: The U.S. government was alleged to have used investigational drugs on military personnel during the Gulf War without their consent. In Doe v. Sullivan, a federal court refused to enforce the informed consent requirement because of the impracticality of obtaining consent under the circumstances (Doe v. Sullivan, 938 F.2d 1370 [D.C. Cir. 1991]). This exception to informed consent is obviously a very narrow one.
Contact the author at siang@hawaii.edu.