The triage officer takes the MGCD0103 decision without consent of the patient which can be regarded as the paternalistic approach of decision making. A study [46] published in 1994 on refusal of emergency care showed that among 106 refused patients, 35 (33%) had appropriate

visits and four of them had to be hospitalized. Refusal was based on the triage guidelines which mentioned ‘non-emergency complaints’ so the author concluded that the guidelines were not sufficiently sensitive. Thus, such refusal Inhibitors,research,lifescience,medical to emergency treatment conflicts not only with the principle of respect of autonomy but also with the demands of good quality care in emergency services. When looking at the viewpoint of the care provider, we see that the decisions are being made by the triage officer or the concerned authority of the ED. Triage is the initial step in the evaluation of a patient’s complaint(s) before initiating medical evaluation and management and generally, informed consent is not considered as a part of triage process [17]. Inhibitors,research,lifescience,medical In addition, there is exemption from informed consent requirements even for emergency research [47]. Emergency treatments can be

given under the doctrine of Inhibitors,research,lifescience,medical necessity if an adult patient lacks capacity to give consent [48]. Given the urgent character of emergency situations, respect for autonomy in the form of informed consent is often not the first ethical priority, which is perfectly normal because the urgency of the situation does not provide room for it. In such situations, the necessary care should be provided instantly. Nevertheless, Inhibitors,research,lifescience,medical the fact that informed consent cannot factually be realized in many ED situations does not mean that respect for autonomy cannot be taken into account at all here. Davis et al reported that even acutely

ill emergency patients preferred respect for autonomy in medical decision making and increasing acuity of illness at presentation does not predict a decreased desire for autonomy [49]. An important way of respecting autonomy as much as possible here is by focusing on good and clear ED communication. To exercise respect for autonomy, health care workers must be able to communicate Inhibitors,research,lifescience,medical well with their patients. However, the emergency department (ED) presents unique challenges to effective provider-patient communication, such as lack of privacy, over noise, frequent interruptions, and lack of an established medical relationship. A study on ED communication concluded that the physician-patient encounter was brief and lacking in important health information such as specifying symptoms that should prompt return to the ED [50]. Good communication requires, most importantly, listening as well as talking and is usually necessary for giving patients information about the proposed intervention and for finding out whether patients want that intervention [51]. Triage officers should routinely inform patients about their triage level, and their estimated waiting time before being seen by the doctor [52].