First Aid/Consent

Importance
Most people and cultures involve a certain amount of respect for a person's personal space. This varies with cultural and personal attitude, but touching another person is generally considered to be rude, offensive or threatening unless their permission is gained.

As most first aid treatment does involve touching the victim, it is very important that the first aider gains their permission, so as to avoid causing offense or distress. In most jurisdictions, it may be considered battery if a first aider touches the victim without permission.

Gaining consent
The simplest way to gain consent is to ask the victim if they will allow you to treat them. Talk to the victim, and build up a rapport with them. During this conversation, it is important to identify the following key points:
 * Who you are - Start with your name, and explain that you are a trained first aider.
 * Why you are with them - They are likely to know they have an injury or illness (although you can't always assume this in the case of patients in emotional shock, children or those with learning difficulties), but explain to them that you would like to help with their injury or illness.
 * What you are going to do - Some first aid procedures can be uncomfortable (such as the sting which accompanies cleaning a wound with saline), so it is important to be honest with the patient about what you are doing, and if necessary, why it is important.

Implied consent
There are some cases where you can assume that the victim gives their consent to you treating them. The key, unequivocal reason for assuming consent is if the patient: In these cases, you can perform any reasonable treatment within your level of training, and your position is protected in most jurisdictions.
 * Is unconscious
 * Has a very reduced level of consciousness

Judgment of consent
There are also some cases where the first aider may have to exercise a level of judgment in treating a victim who may initially refuse. Cases like this include when the victim is:
 * Intoxicated
 * Irrational (i.e. delusional, insane or confused due to the injuries)
 * A minor (parent or guardian must give consent if present and able; otherwise consent is implied)
 * Suffering from learning difficulties

In these judgment cases, the first aider must make a decision, even if the victim is refusing treatment. If this occurs it is very important to make a note of the decision, why it was taken, and why it was believed that the person was unfit to refuse treatment. It is advisable to summon professional medical assistance if you believe the victim should be treated and is refusing, as medical professionals are experienced in dealing with people reluctant to accept treatment.

Wishes of relatives
In some cases, relatives may object to the treatment of their relative. This can be a problematic area for the first aider, with several important factors to be considered.

In the first instance, it may not be any decision of the relative to choose to consent to first aid treatment. In most countries, the only time this decision can be definitively taken is if the person requiring treatment is a child.

In other cases, the presumption for the first aider must be towards treating the victim, especially if they are unconscious.

The other main consideration is if the person claiming to refuse consent on behalf of the victim is in fact a relative, or if they have the victim's best interests at heart. In some cases, the person may have caused harm to the victim. If in this case, you fear for your safety, or the person becomes aggressive, you should look after your own safety as a priority, and call for assistance from the police.

Advance directive
Some victims may have a statement recorded, called an advanced directive or living will, that they do not wish to be treated in the case of life threatening illness. This can be recorded on a piece of paper, or on wearable items such as a bracelet.

The legal force of these items may vary widely between countries. However, in the majority of cases they should follow a certain format, and be countersigned by a solicitor or notary public.

In any case, as suggested above, the first aider should always presume towards treating a victim, allowing health care professionals to make the final decision. Almost every first aid treatment will only extend life, rather than definitively save it, meaning you are usually not breaking the advance directive. This includes actions such as CPR, which simply extend the time until which definitive treatment will work - usually delivered by a health care professional, who can make their own clinical decision on any advance directive.