Assent

End of Life 

In complex cases like this one, it can be helpful for clinicians to provide recommendations. It can be very challenging to provide recommendations at the end of life and warrants, at a minimum, ensuring all clinicians agree. When all clinicians agree a treatment is not medically appropriate or futile, then clinicians should give recommendations using an informed assent/non-dissent format. Informed Assent/non-dissent means a clinician(s) provides medical recommendations in a statement form and the patient or surrogate assents (agrees) or non-dissents (does not disagree) with the recommendations. Informed assent/non-dissent does not require verbal agreement, it requires the patient or surrogate understands the plan and does not disagree.1-3 

1. Curtis JR, Burt RA. Point: the ethics of unilateral “do not resuscitate” orders: the role of “informed assent”. Chest. Vol 132. United States2007:748-751; discussion 755-746. 
2. Kon AA. Informed non-dissent: a better option than slow codes when families cannot bear to say; let her die. Am J Bioeth. 2011;11(11):22-2 
3. Curtis JR, Kross EK, Stapleton RD. The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). JAMA. Published online March 27, 2020. doi:10.1001/jama.2020.4894