Ethics of consenting the 'unconsentable'.

Purpose: The purpose of this review is to highlight important ethical aspects of informed consent in the unconsentable patient or participant.

Recent findings: Recent research and guidelines stress the need for detailed and honest communication respecting patient autonomy and the standards of informed consent. Emphasis is placed on full disclosure and guidance. This includes informing patients and participants of the use of data collected and individuals involved in therapy or research.

Summary: Informed consent is a legal process and there are standards that must be maintained. Whether in clinical practice before a procedure or therapy, or within research participation, informed consent must be obtained from individuals with mental capacity. However, in those who lack such capacity, an emergency exception can be used in dire situations but only once a concerted effort is made to locate a surrogate. Even so, the decision made must be in keeping with respecting the individual's prior known wishes.