Don't Skirt Informed Consent. (Guest Editorial)

By Merritt, Eli | Clinical Psychiatry News, June 2003 | Go to article overview

Don't Skirt Informed Consent. (Guest Editorial)


Merritt, Eli, Clinical Psychiatry News


The great split inpsychiatry between biologic and psychological treatments extends back centuries in the history of medicine. Because of this dichotomy, doctors and other healers have tended to offer patients one form of treatment or the other.

But rarely have both forms been offered to patients.

Today, this biologic-psychological divide remains. As a result, many non-physician therapists fail to refer their patients for needed medication treatment, and many psychiatrists restrict their patients to a "medication management only" model without offering them either therapy or appropriate referrals to qualified therapists.

Both of these approaches are wrong and, according to medical ethics and evidence-based psychiatry standards, both of them violate the principle of informed consent.

According to the preeminent textbook of ethics, "Principles of Biomedical Ethics" by Tom L. Beauchamp and James F. Childress, there are five necessary components of informed consent: disclosure, understanding, voluntariness, competence, and consent.

For the purposes of this discussion, I will focus on four of the criteria:

* Disclosure. When assessing injuries to patients and making determinations about compensation, lawyers and judges deem disclosure to be the sine qua non of informed consent.

What is required in disclosure is more than a careful explanation to patients of the risks and benefits of a specific treatment recommended by a health care provider.

It is also essential that the provider be required to fully disclose to patients the risks, benefits, and outcomes of alternative treatments.

In contemporary psychiatry, such disclosure means summarizing to patients the evidence-based outcomes of psychological, biologic, and combination treatments for the disorder at hand.

* Understanding. Linked to the requirement of disclosure is the need for understanding.

It is not enough for a provider simply to state that alternative treatments exist. Instead, doctors and therapists must ensure that patients understand the disclosed information in a capacity that is adequate for those patients to make an informed choice.

To accomplish this, providers must explain treatment options in a manner that is both unbiased and jargon-free. Furthermore, providers must allow ample time for the questions and clarifications that are necessary for a patient to make a decision.

* Voluntariness. Informed consent strictly requires that a patient freely consent to a treatment without undue influence or coercion by the provider.

Beauchamp and Childress define the condition of voluntariness as the patient's right to act "independent of manipulative and coercive influences exerted by others in order to control the person.

One act that can be characterized as an example of coercion and control is misrepresentations of the medical literature.

Another example is expressions of disapproval of alternative treatments.

Threats of abandonment based on a patient's choice are another example of coersion and control. …

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