Ways of Knowing Essays

Informed Consent for Colonoscopy
Name: ___________________________________ Procedure Date: _____________ Time: ___________ Location: The University of Chicago, CENTER FOR CARE AND DISCOVERY.
1. I, ____________________________________________ (patient or guardian) give consent for Dr._____________________ or his/her associates to perform a colonoscopy with possible biopsy, removal of polyp(s) with possible coagulation/injection therapy of blood vessels or tissue, and control of bleeding if necessary.
2. I understand this procedure involves the passage of a digital optic instrument through the rectum to allow the physician to visualize the interior of the large intestine (colon). Sedation and pain relieving medications may be given to minimize discomfort and relax me for the procedure. These medications may cause localized irritation and/or a drug reaction. I understand that with the anesthesia/sedation for this procedure I will not be able to drive the remainder of the day and I should not have plans after the procedure. I understand that I MUST HAVE A DRIVER take me home.
3. I understand the reasons for the procedure which have been adequately explained to me by my physician. I understand I may call the office where I regularly see my physician with any questions about the preparation or procedure. I have had ample opportunity to ask questions before signing this consent.
4. RISKS: Possible complications of this procedure include, but are not limited to: bleeding and tearing or perforation of the bowel wall. These complications, should they occur, may require surgery, hospitalization, repeat colonoscopy, and/or a transfusion. Perforation of the bowel is a known, but rare complication which can occur at a rate of 1 per 1,000 colonoscopies. Bleeding, usually after a polyp removal, can occur at a rate of 1 per 1,000 colonoscopies and continue up to two weeks after a polyp is removed. Other extremely rare, but serious or possibly fatal risks include: difficulty...