Posted by: Jacqueline O'Doherty | September 13, 2010

Informed Consent

Articles have appeared recently in the NY Times and the Boston Globe, addressing medical consent. Medical informed consent can be vexing to all, including the patient, the patient’s family and the physician. When patients undergo any medical procedure, informed medical consent is required. The key word in that phrase is “informed”. Ethically no procedure should move forward until the patient has a clear understanding of what the procedure entails and the possible outcomes, benefits and consequences. In addition the patient needs to be aware of all her options, including the option to not treat. She also needs to know the possible outcomes of each option. It is the patient’s choice to accept or decline treatment. It is the patient’s choice, not the hospital’s, nor the physicians. Society recognizes the patient’s right to autonomy and self determination, which permits the patient to give informed consent based on her own values and beliefs.

The argument is that because many procedures are so complex; the patient may not understand all of her options. Or the patient may just be so overwhelmed by the diagnosis and prognosis; she is unable to sort through all of the information to come to a clear understanding of the options available to her. These are valid observations. However, that does not excuse or relinquish the responsibility of the physician to gain informed consent from the patient. Just as important, informed consent needs to go beyond the procedure, informed consent needs to encompass all the outcomes that may happen as a result of the procedure. Informed consent should be an ongoing process; it doesn’t always end after the initial procedure.

Recent research has also shown that while physicians believed their patients have understood and grasped the information they had discussed, in reality the patients had not. Why is this? Perhaps it is the physician talking in “medical-eze”, perhaps it is information overload, perhaps the patient is too distressed and overwhelmed to hear and comprehend what is being said. Regardless of the reason, it is imperative the patient has the resources to give informed consent.

Once again, this is where the Patient Advocate comes in. Every patient needs to have someone by their side, advocating for them, when they are making medical decisions. The patient needs an advocate who can help them sort through the medical muddle and the fog of apprehension and fear. The essence of informed consent is the informed part. The Patient Advocate ensures the patient understands the diagnosis and prognosis, the benefits and consequences and all of the options available. This gives the patient the freedom to choose which medical choice is best for her, allowing her to give clear informed consent. Always have an advocate, don’t navigate the healthcare system alone.

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Responses

  1. Thanks for this great article on “informed consent” in terms the general consumer can understand…As a Patient Advocate, too, I always encourage a patient to “trust their gut feeling.” You intuition should never be shoved under the rug. Don’t be intimidated by a doctor’s not-so-kind-reaction to your questions. Get second and third opinions. Only make medical decisions when you are 100% confident that you understand and have studied all the information from every possible angle.


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