Informed Consent
Created by Catherine Rainbow for an undergraduate course at Davidson College.

Currently informed consent is a hotly debated topic because the fashion in which it is practiced rarely corresponds appropriately with its purpose. The purpose of obtaining informed consent is to verify that patients have been fully informed of available treatment options including their potential dangers. This means that the patient understands each option and can make a decision in accordance with their acceptable quality of life. Although the original purpose of informed consent was to protect the patients' right to autonomy, informed consent has now evolved into being a form of evidence that protects physicians from medical malpractice.

In this day and age, 'time is of the essence,' especially for physicians who are trying to treat as many patients as possible in a given day. This means that some physicians will try to obtain a patient's informed consent relatively quickly in order to be able to perform the procedure and move onto the next patient. In order to save time, physicians will only offer a limited number of options with little explanation and may pressure the patient to sign the consent form quickly. When physicians obtain informed consent from their patients in this manner, they are denying their patients the information required by the consent form. Patients will not be able to make educated decisions because they have not been given the opportunity to understand the available options. This lack of education may lead to patient dissatisfaction with their treatments and physicians. However, once a physician has obtained the patient's informed consent, the physician is no longer held liable for malpractice as long as the procedure goes as planned.

Patients who sign consent forms before understanding the procedures are placing themselves in a great deal of risk. The physician who is advocating one type of procedure may be biased towards that procedure for various reasons. Perhaps the physician will earn more money if he performs a specific type of procedure. The physician may also be a strict paternalist who believes that it is the doctor's duty to decide the patient's treatment regardless of the patient's will. For instance, a patient may prefer to live without taking medications that have debilitating side effects rather than prolong their life. In this instance, the patient emphasizes his quality of life over his quantity of life. In this situation it would be critical that the patient understand his options for treatment so that he obtains the quality of life that he wants instead of living a miserable life determined by the physician's agenda to maximize the patient's life span

Patients who believe that they were not properly informed feel like they are victims of a paternalistic physician society that denies them their autonomy, one of the principles of ethical theories. The physicians who ignore their patients' rights run the risk of hurting the entire medical profession. For instance, the patient-health care provider relationship is built on trust that the provider will respect the patient's autonomy, deliver good medical treatment and will keep the patient's records confidential. Once the patient feels like a victim due to the hasty informed consent process, he loses respect for the medical field. In essence, the physician has destroyed the very trust that allows him to practice medicine. If the patients do not solicit the physician's advice due to bad experiences, then the physician will be out of a job and the patients may suffer needlessly because they refuse to see a physician.

In order to restore the patient-physician relationship, physicians need to reevaluate their execution of informed consent. If the physicians truly want to inform their patients, then they will take the time to explain the various options. Physicians have the obligation to explain the basic procedures and treatment to the patient in lay terms that they will be able to understand. The patients have the right to know what the most frequent complications are and what the likelihood is that the procedure will have permanently detrimental effects upon their body. For example, a physician performing surgery could tell the patient where the cuts will be made on the patient's skin as well as what major organs will be cut or sutured and what the patient will probably expect after surgery including recovery time and the amount of pain. Although the physician has the duty to inform the patient of the potential dangers of a treatment, the physician also has the ability to inform and encourage the patient with success rate of each treatment.

Physicians also have the responsibility to inform their patients about the medicine they will take in order to treat a medical condition. In this case, physicians should explain the most frequent side effects of drugs such as the top five to ten side effects that may restrict the patient from his everyday activities. The drug companies, however, share a large part of the responsibility of informing the patient the side effects associated with each of their medicines. They should, as they already do, list all of the possible side effects upon the person's temporary and permanent health in a brochure that accompanies each of their products.

In order to assure that the patient understands the effects of a medical treatment upon his life, then the physician must obtain informed consent only when the patient has the ability to make a decision. This means that the patient should be competent, fully aware of his surroundings, and able to understand the purpose of the medical procedure. The patient should also have at least a general understanding of the consent form and should be encouraged to ask questions. The process of informed consent will take much longer if executed in this manner, but the patient will regain some trust in his physician and should be happy with his personal decision.

The hasty practice of informed consent by paternalistic physicians can lead to the breakdown of the patient-physician trust and relationship. Patients who have been rushed into making a decision with little pertinent information often feel like victims of the medical society. However, the loss of patient-physician trust can be regained if physicians take their patients' autonomy seriously by providing them with the information required by informed consent so that the patients understand the consequences of their treatments. Although this process may take longer, the physician will successfully treat his patients who will be happy with their decisions, quality of life and care provided by their physician.

© Copyright 2002 Department of Biology, Davidson College, Davidson, NC 28035
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