The health industry is constantly under pressure, making split-second decisions to save lives. In these life-or-death moments, there is little time to stop and explain complex procedures or to confirm understanding before acting. An overwhelmed patient might nod in agreement, sign a form, or give verbal consent in the hallway, but later question what they agreed to. With the pressure to act swiftly, the lines of informed consent can become blurred. We take an in-depth look at the challenges surrounding consent in urgent surgical scenarios in Australia and examine what constitutes valid consent, where the current system may fall short, and what can be done to ensure that even under pressure, patients are truly informed.

In Australia, valid informed consent is a legal requirement. Whether the procedure is routine or urgent, the consent process must ensure that the patient has been given enough information to make a voluntary, informed decision and that they have the mental capacity to do so at the time. According to the Australian Commission on Safety and Quality in Health Care the goal is for patients to feel empowered to ask questions, express concerns, and understand what to expect. But that can be difficult when time is short or communication is rushed.

Consent goes beyond signing a form. The goal is meaningful understanding, which can be compromised by factors such as anxiety, overwhelm, pain, medications, language barriers, or the emotional strain of facing surgery unexpectedly. Yet, even in these circumstances, clinicians have a duty of care to ensure patients are not misled or inadequately informed.

When it comes to urgent or emergency surgery, getting proper consent can be very difficult. One of the most immediate barriers is time. Clinicians may feel pressure to act quickly to prevent deterioration or save a life. In these situations, a brief explanation followed by a signature may seem sufficient. However, even in emergencies, the requirement for informed consent remains unless the patient is unconscious and immediate action is necessary to preserve life or prevent serious harm.

The role of substitute decision-makers adds another layer. When a patient lacks capacity, consent must be obtained from a legally appointed guardian, an enduring power of attorney (medical), or, in many states, a person recognised under guardianship legislation. This process can be unclear or delayed, especially outside of regular hours or in rural hospitals.

As outlined in the NSW Health Consent to Medical Treatment Manual clinicians are expected to take “all reasonable steps” to inform patients, even when time is short. But what qualifies as “reasonable” in an emergency remains a grey area. One that leaves healthcare providers navigating risk, ethics, and urgency all at once.

Not getting proper consent from a patient before surgery can lead to serious legal consequences, even if the surgery goes well. In Australia, if a patient later says they didn’t understand what the procedure involved or the risks, the doctor could be accused of negligence.

A key court case, Rogers v Whitaker (1992) made it clear that doctors must explain any risks that might matter to the patient, not just the ones they think are important. The High Court dismissed an Appeal brought by a Sydney ophthalmologist against an award made against him by a patient blinded by sympathetic ophthalmia occurring in the opposite eye to the one treated.

Hospitals can also be held responsible. They’re required to have systems in place to help doctors get proper consent, like interpreters, clear forms and staff training. If those systems aren’t working, the hospital could be blamed if something goes wrong. It’s not just about getting a signature; it’s about making sure the patient truly understood and agreed. In emergencies, proving that can be tough, which is why good records, clear communication, and strong support systems are so important.

This puts clear, empathetic communication at the heart of best practice. Even in time-sensitive situations, clinicians can improve patient understanding by using plain language, summarising key risks and benefits, and inviting questions where possible. A brief but thoughtful exchange may be more effective than a rushed delivery of technical details.

Shared decision-making is not always about long discussions. As outlined by the Australian Health Practitioner Regulation Agency (Ahpra), it’s about respecting the patient’s right to understand and participate in their care, even when time is limited. A simple phrase like “Let me quickly explain what’s happening and why it matters” can set the tone for more collaborative interaction, even under pressure.

Clinicians working in high-pressure environments face a dual challenge: acting quickly to protect patient health while also fulfilling their ethical and legal obligations around consent. Ultimately, the goal is not perfection, but progress: improving the quality of consent even when time is tight, and ensuring patients are never reduced to passive participants in their own care.

One of the most effective ways to support clinicians is through targeted education. Regular training on consent, especially case-based and scenario-driven learning, can help healthcare workers navigate difficult conversations, recognise when a patient’s understanding may be compromised, and adapt their approach accordingly. These sessions should include updates on legal obligations, cultural competence and communication strategies under time pressure.

Digital innovations may also offer solutions. Electronic consent platforms with built-in prompts, plain language summaries, and options for video explanations could improve both comprehension and documentation. In fast-paced clinical areas like emergency or intensive care, tablet-based systems may help standardise the consent process and reduce reliance on memory or rushed conversations.

Getting proper consent from patients is a basic part of ethical and legal healthcare in Australia. But when surgery needs to happen quickly, getting that consent can be tricky. There may be very little time, the patient might be in pain or confused, and the situation can be stressful for everyone involved. Still, it's vital that patients understand what’s going to happen, why it's needed, and what the risks are, before they agree to treatment.

For doctors and nurses, this can be a tough balance. They need to act fast to help their patients, but they also need to make sure those patients understand and agree to what’s being done. Hospitals also play a big role. They need to make sure their staff have the right tools and support, like interpreters, clear information sheets, and proper training, to get consent the right way. There’s no perfect way to do this, but there are better ways. Clear communication, taking a moment to explain, and better systems can help. Even in emergencies, patients deserve to be involved in decisions about their care.