Medical Consent: There seems to be a big confusion as to what exactly is consent. I will try to explain what it is, and how it applies to COVID vaccines.

First, in order to obtain consent, a provider must determine if the patient is competent and has capacity. To be competent, a patient must be the person who makes their medical decisions. For example, a minor (patient under the age of 18) is almost never the person who makes their decisions. The decisions are made by their proxy. Capacity is determined by the patients mental state. The patient must be aware of themselves and their surroundings, which in most instances is demonstrated by being aware of person, place, time, and events leading. Capacity can be lacking for several reasons, and can be either temporary of permanent. Examples of lacking capacity is alcohol intoxication (temporary) and dementia (permanent).

Second, the provider must ensure that the patient understands the medical treatment. Explaining why a treatment is required and/or recommended, what the treatment entails, and what would be the benefits of the treatment.

Third, the provider must inform the patient of any possible consequences of the treatment, including side effects, limitations of the treatment, or possible negative outcomes of the treatment.

Refusal of a treatment still requires the above test. By refusing a treatment, a patient needs to be competent, have capacity, understand the treatment being refused, and understand the potential consequences of refusal.

By applying this to the refusal of a COVID vaccine, we arrive at the following: If a person refuses the vaccine, (assuming competence and capacity), they understand:

• what is the vaccine
• why it is recommended
• what are the benefits of the vaccine
• what are the potential side effects of the vaccine
• what are the potential complications of getting the vaccine
• What are the potential consequences of not getting the vaccine

One of the potential consequences of not getting the vaccine is that a person may not be allowed to participate in an activity that they would be able to participate if they got the vaccine. In a public health crisis, regulations can be enacted to protect the public health. There is plenty of case law that has supported this concept.

Why should someone listen to me about medical consent? It is a large part of what I do. EMS providers have the highest percentage of refusal of treatment of any healthcare provider (in excess of 25% of the patients I encounter refuse care).