negotiorum gestio ( ng ) is a legal term which , translated from latin , means it denotes an action where the  gestor  as an intervenor acts on behalf , and for the intended benefit , of another person ( the dominus negotii ) , however without obtaining the latter 's prior consent ( see , e.g. , ) . in broad terms , the conduction of ng - like actions previously was not uncommon in health care provision . consistent with an authoritarian (  paternalistic  ) view on health care , various treatment deliveries , physical examination , and so forth were customarily performed with only little or very implicitly presumed patient consent . meanwhile , in continuation of bioethical principles of patient autonomy and self - determination , informed consent ( ic ) obtainment to health care intervention has been increasingly implemented internationally as both an ethical and a legal imperative [ 3 , 4 ] . for example , in continuation of autonomy principles , the european bioethics convention ( council of europe , 1997 ) maintains in its article ( article 5 ) that  an intervention in the health field may only be carried out after the person concerned has given free and informed consent to it . this person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks . it is not said in article 5 what form the ic must take ( oral or written ) . in everyday practice , a universal claim for writing hardly would be practicable and oral ic therefore is widely accepted though signed ic would be obligatory in some ( typically larger ) interventions . quite another aspect is the possible duty for doctors to record the ic in patient charts . similar to international recommendations , requirement for ic has been widely implemented in national regulations , and so is the case in denmark . according to the danish act on health care para 15 ,  no treatment may be commenced or continued without the patient 's informed consent (  )  ( para 15 ; act 1202 , dated 14/11/2014 ) . as a rule according to danish law , oral ic is sufficient yet exceptions may exist ( see , e.g. , demand for written ic to living organ donation according to para 52 ) . so far , from a legal perspective , ng in health care is a  no go . some remarkable exceptions however remain in formal law , that is , by way of an example , acute situations where a patient temporarily is not decision competent ( the traffic victim brought in an unconscious state to the emergency ward in need of acute intervention , etc . , compare danish act on health care para 19 and  necessity  ; see also , e.g. , ) . with regard to information obligations , it is stated in the danish act on health care para 16 that  a patient has a right to get information about his or her state of health and about treatment options including their associated risks (  ) . it is maintained as well that information must be continuously delivered , comprehensible , and individualized according to the patient 's qualifications ( ministerial order 161 , dated 16/09/1998 , concerning informed consent obtainment , etc . ) . information should include relevant modes of treatment , alternatives , and consequences of withdrawal from treatment and it must be more comprehensive when there is a conceivable risk for serious complications or side effects . in everyday clinical practice , health professionals seem to be presumed to be updated about all important information and how to distribute and communicate it to patients . as health professionals commonly seek to do their best and are required to exercise diligent conduct ( cf . the danish act on authorization of health professionals , para 17 ) , this arrangement at first appears reasonably straightforward . nevertheless , dilemmas intermittently arise when it comes to the administration of ( all ) relevant information while reaching a sensible decision , making use of the professional know - how , and wishing to serve patients well . in order to illustrate the legal consequences of failed ic obtainment and possible solutions to the  how and how much to involve patients  problem , a tenet malpractice lawsuit concerning family medicine , judged by the danish health professionals ' disciplinary board , is described below . the case decision is publicly available on the danish health professionals ' disciplinary board 's homepage ( http://www.patientombuddet.dk/ ; case number 0021330 ) . in the following , , the patient had visited her family doctor in connection with her pregnancy . during the consultation , the family doctor  routinely took blood samples to test for hepatitis , hiv , syphilis , and rubella . a week afterwards , the family doctor was notified by the laboratory that the hiv test was negative yet , few days later , the laboratory informed that this test actually had been inconclusive and that another one should be made . the family doctor contacted the patient by mail and asked her to have another blood test taken at the laboratory as there lacked a test result from the first test . again , a message from the laboratory said that the hiv antibody test was inconclusive . therefore , the laboratory recommended another hiv test type which had to be repeated three months later in order to completely rule out the presence of hiv . the complainant claimed that the defendant family doctor originally took blood samples , including an hiv test , without proper information . it was not clear from the medical records that information had been given to the patient . the board stated that there is an obligation to obtain a patient 's informed consent before the ( e.g. , hiv ) blood sample is taken and therefore upheld that there was an obligation for the family doctor to obtain the woman 's informed consent before taking the tests , including the hiv testing . consequently , it was ruled that , during the first encounter , the litigant family doctor had violated authorization act obligations ( cf . the legal requirement for informed consent ) , because she had not been sufficiently diligent in her information of the patient in connection with taking blood samples , including hiv testing . it was recently proposed that   preference misdiagnosis ' may be the most common form of medical error in health care  . patients ' ic often is based on the health provider 's inaccurate picture of patient information ,  guidance  needs , and treatment liking . the reasons may be numerous including patients ' habituation to rely on doctors making health - related decisions , notions of  professionalism  that patients should be  spared  from both the tough decisions and many everyday choices , and so forth [ 7 , 8 ] . best option among more reasonable alternatives as well as patient preferences can be validly deduced from the clinician 's medical experience . in other words , it may be tempting to lean towards the ng approach . as it is illustrated in the case mentioned just above this innately entails some judicial aftermath : from a legal perspective , without correct information , no valid consent is obtained . so , without being legitimated by , for example , necessity , the family doctor unlawfully acted on behalf of the patient . in accordance with basic bioethical principles of patient autonomy and self - determination and legal requirements for ic obtainment , the disciplinary board concluded that this was unlawful professional conduct and issued the family doctor with a written reprimand . questions then arise like the following : how to ensure provision of relevant information in a way that can be taken in while respecting individual patient needs ? how to protect patients from information overload ? and how to help patients make the right decision without  misdiagnosing  patient desires , while simultaneously complying with ic law requirements , maintaining professionalism , and averting litigation and reprimands ? many health care professionals dealing with the task of information delivery and patient communication will realize this sometimes to be a difficult task . as a consequence , some clinicians may stick to the pitfall of concluding that it is most safe to provide the entire spectrum of information ( all pros and particularly all the cons ) . nevertheless , in many situations , this seems professionally unsatisfactory . at the same time , it is well known to most clinicians that failure to provide the information which the patient afterwards perceives as  relevant  may result in dissatisfaction , grave disappointment with health care provision , and complaints . consequently , there is a great variation among doctors ' information practices and basically unwanted unevenness in regard to what information is provided to the concrete patient . as a possible solution to this problem , sdm approaches have been proposed as a corrective for unwanted practice deviations while also addressing patients ' individual participation and information needs . according to a definition of sdm , it implies  [  ] that at least two participants , the clinician and patient be involved ; that both parties share information ; that both parties take steps to build a consensus about the preferred treatment ; and that an agreement is reached on the treatment to implement [  ]  . notwithstanding sdm requires the health professional to provide all of the relevant medical facts and statistics on treatment options to patients . as few clinicians can quote accurate statistics from memory or eliminate their personal biases in a manner required to provide an objective presentation of the options (  )  and furthermore sometimes may be tempted to nudge  the patient or in any case  (  ) vary significantly on what information and risks they feel are important in making treatment decisions , which often leads them to make very different choices (  )  , standardized  decision aids  ( das or  decision tools , e.g. , web - based interactive programs ) have been developed to assist patients and clinicians to systematically and uniformly access risk information along with highlighting patient preferences , without resorting only to memorization and physician variability . during the sdm process , patients are supported to identify individual preferences and consider features and consequences of options in order to identify informed preferences and choose the best course of action . after completing the da it can be used for the subsequent ( mandatory ) patient - physician encounter . at the same time it may provide a means of documentation . sdm and das have further advantages of rendering a more uniform procedure of ic obtainment possible across , for example , health care sectors and borders . there has been increasing recognition of sdm and das as measures to enhance patient involvement in decision - making ( dm ) , decrease decisional conflict , and improve health care communication in the substantial proportion of clinical situations where more options are reasonable alternatives . with particular relevance in the present context , it should be mentioned that sdm da is also available for use with hiv tests . while in many countries annual numbers of malpractice lawsuits have been steadily increasing and lack of communication and information exchange seems central to patient dissatisfaction leading to malpractice litigation , it is tempting to hypothesize that sdm and das could serve also functions of increasing satisfaction and decreasing patients ' need to complain [ 1315 ] . application of such measures possibly could be a step towards better compliance with bioethical principles and potentially would safeguard information provision as well as consent obtainment when embedded in the da . had the patient in the case described above been subject to a similar approach , it is likely that a complaint never would have evolved . if a complaint had evolved anyway , there likely would be less problem in documenting the course of ic obtainment . the disciplinary decision described in this paper opposes the intermittently expressed belief among medical doctors and others that when all comes to all , patients want the doctor to decide . patients actually maintain their right to have information and to participate in health care decision - making . ng - like acts and behaviour , in addition to causing unfortunate practice variation and unpredictability for patients , put excessive responsibility on the doctor , which sometimes can be hardly honoured . in this context , attention can be drawn to the well - known alma - ata declaration stating that patients not only  have the right  but also have the  duty to participate individually [  ] in the planning and implementation of their health care  . if ng is carried out anyway , it potentially will be  repaid with nothing but ingratitude  in a health disciplinary tribunal . in a rising number of everyday clinical situations , sdm das have been developed which possibly might prevent ic duty breaches in a practicable way , would provide some documentation of the ic process thereby helping doctors coming up to medical records keeping requirements , and perhaps could decrease patients ' need to litigate .
introduction . 
 negotiorum gestio ( ng ) denotes an action where a person well intendedly acts on behalf of another without obtaining the latter 's prior consent . in broad terms 
 , ng - like actions have played a considerable role in health care provision . in some settings , health care delivery with only little or presumed 
 patients ' consent has been the rule rather than the exception . 
 however , bioethical principles regarding patient autonomy and obtainment of the patient 's informed consent ( ic ) before intervention are now increasingly materialized in the law of many countries . aim . to study legal consequences of ng in family medicine and ic handling options . 
 methods . 
 case law examination . results . 
 a disciplinary board case is described concerning a family doctor conducting unlawful ng by not coming up to legal ic requirements . 
 discussion and conclusion . 
 the practical and legal implications of ic and possible role of novel shared decision - making approaches in coming up to regulation and bioethical demands are discussed . 
 it is concluded that a doctor may run an unnecessary legal risk when conducting ng in decision - competent patients and furthermore it is suggested that novel shared decision - making approaches could help in obtaining a rightful and practicable ic .