The Informed Consent Event
In order to fashion a synthesis of the various agendas and perspectives that weigh upon us, we have elected to give primacy to an informed consent event in our account, however much it may need to be augmented by a surrounding process. The informed consent event has three distinct stages, each aimed at quite different though complementary goals: (1) the comprehensive disclosure stage, which will roughly approximate the detailed presentation of risks, benefits, and alternatives of a given intervention required by American law but will be aimed at more modest goals, such as providing the patient the opportunity to rule in or out regarding hesitancy, ambivalence, or misconceptions; (2) the core disclosure stage, which will attempt to counter the information-overload tendency of the first stage and give patients something relatively simple and structured that they might minimally react to and evaluate—namely, the essential choice at hand; and (3) the assessment, clarification, and patient choice stage, which will be the only necessarily interactive part of the informed consent event (unless the patient spontaneously chooses this mode at any other point), and which will key to the specific patient's level of understanding and other concerns. This stage will proceed by probing into the patient's understanding of the information provided in the preceding two stages and will respond to this with appropriate clarification of the patient's developing sense of the issues at hand.
As we proceed through each of the three stages, four basic issues will repeatedly face us. (1) What are the explicit, intended goals of each stage? (2) What specific content should each stage have? (3) How will this content be arrayed so as to be maximally accessible to the patient? Much more than a shopping list is required to pursue the goals we have identified. (4) What sort of variables may modify the conduct of each stage, either as part of the discrete event, or toward triggering a longer process of education and counseling?