As a rule: surgical interventions in MSF projects are only permitted with the explicit consent of the patient!

Consent requires understanding – all information that is required must be given in an appropriate way (culturally appropriate, in his/her/their own language), this is the meaning of informed consent. If a patient does not understand what will happen to him or her, he/she can not consent. Furthermore, consent should be voluntary and patients should have appropriate capacity to consent.

Patients might be unable to give consent in some circumstances:

too sick to understand the consequences (unconscious, obtunded, delirious)
too young to give consent (legal age varies in countries)

In those cases, the law requires a substitute decision maker (this could be a family member or a judge) to decide for the patient and in the best interest of the patient.

Only in situations where time does not permit to wait for a substitute decision maker to arrive, and life or limb are at stake, then the medical team may assume consent and proceed. If done, careful documentation is essential: indication, urgency and the reason why consent cannot be obtained should be clearly documented and signed by at least two qualified health care providers.

Hospitals must have clear rules in place on how to deal with emergency cases when legal consent cannot be obtained. This must be discussed and agreed upon before such a situation arises. This is important for all procedures but crucial for surgical interventions with serious irreversible consequences like amputations or emergency hysterectomies.

1. CMPA. Consent: A guide for Canadian Physicians. CMPA. https://www.cmpa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians. Updated June 2016. Accessed Feb 2nd 2021.