Is Your Consent Really Informed?

Informed consent is based on the moral and legal principle that you, as the patient, are in control of the decisions you make about your health care and that you have the right to make decisions about medical interventions, such as tests or treatments. If consent is not obtained before a test or procedure, it is considered legally a form of assault.  Which is to say, no one has the right to do anything to you physically without your permission.

It is the doctor’s ethical responsibility to give you the information you need to make such a decision as to whether or not you agree to undergo a procedure, test, or treatment. That’s what informed consent means: you, the patient has been informed about the risks of the procedure and you agree based on the information you received.

In practice, however, informed consent is quite complicated. The patient is usually given a document, sometimes a lengthy one, to sign.  It is often written in medical terminology that the average patient doesn’t understand.  Physicians are supposed to provide appropriate information but it’s the physician who makes the decision about what is appropriate.  The physician can tell the patient very little and consider it adequate.  The focus, then, is not on what the patient needs to know or what the patient understands, but what the physician decides to tell.

Patients are often reluctant to question their doctors who are busy and aren’t always eager to sit and answer questions. It is also sometimes the case that patients don’t want to hear too much information about potentially adverse effects or poor outcomes.  They trust their doctors to take care of them and they don’t want to evaluate whether or not a specific test or procedure is really necessary.  The doctor said it was, good enough.  In fact it would be difficult for a patient to be fully informed, that is, actually understand in advance what it would feel like to have chemotherapy or have your chest cracked open for heart surgery.

There are some things patients can do to inform themselves prior to agreeing to a procedure, that is, consenting. They can make sure the explanation is in plain English that a non-medical person can understand.  The patient should say back to the doctor what was understood so that both patient and physician agree on an understanding.  Written or video materials can be requested as well.  Patients can ask about alternative treatments, ask about worse case scenarios, and take notes and bring a person with them to help process the information.  Most important, it is important for the patient to understand that she or he has the right to be informed and that the doctor has the obligation to do so.