Camouflaging Informed Consent
Powell, Clinical Psychiatry News
In 1972, Canterbury v. Spence changed American health law, and with it, the patient-physician relationship. Some ethicists cite this as the beginning of modern medical ethics. Before a patient agreed to a surgical procedure, he was to be informed about its risks and benefits. Failure to do so was negligence. Part III of that appellate court decision gives a concise history explaining why the judges did not consider their decision revolutionary. That, however, wasn't the way doctors experienced it. A decade earlier, arguments had been advanced justifying why it was better not to tell a patient he had cancer. Not all physicians agreed with that practice, labeled therapeutic privilege. But after Canterbury, such paternalism was no longer accept able (with extremely rare exceptions).
As outlined by that court, informed consent is the professional duty to communicate information to the patient. That includes overcoming cultural barriers, poor health literacy, and denial.
The standard for what is contained in informed consent has evolved. Not every minute risk need be discussed. In many states, the requirements went from a professional standard to a reasonable person standard. Then, the whole thing spun out of control.
On taking my mother to the emergency department recently, I was given a binder filled with 32 pages of orientation materials, privacy notifications, and descriptions of patient rights and responsibilities, to a five-page consent form for general medical care. I read it only out of sheer boredom while waiting 6 hours for test results to come back. The 47 pages of information in the discharge packet 2 days later were never read. But what I really wanted was a CD copy of her MRI to take to her follow-up appointment with a different doctor. That, I was told, could be obtained only from Health Information Services, which wasn't open on a Sunday.
This experience has reinforced my prior belief that idolizing autonomy can become counterproductive. …