Informed Consent
Why inform patients?
- Valid consent= “given voluntarily by someone who has the capacity to consent, and who understands what the treatment
involves.
- Relatively recent development
o Rise of patient autonomy
o Past- routine not to tell people they have cancer/will die
- Correct the imbalance of power and information? Patients knowing more.
- Only the patient knows what side-effects and risks matter to him or her?
o Doctor can diagnose and recommend treatment, patients decide what they want/ e.g. not getting rid of a breast or
going into surgery. Also dependent on relatives etc
- Better outcomes?
o More likely to adhere to a treatment plan if you’ve chosen it
- Sign of respect?
o Ask them before you do something to someone’s body
o As a subject, not an object
- BUT ambiguity over what ‘informed consent’ means
o Has the patient been informed if the doctor has told the patient a lot of information they don’t understand?
o Has the patient been informed only if the patient has made an informed choice as a result?
Does it require patient understanding?
- AND patients themselves see the consent form as a bureaucratic requirement, not an opportunity for autonomous
decision.
o How patients view the process of giving consent
o Most patients not understanding consent form as them adding to their own autonomy
- Very few patients think the purpose of the consent form is to enable them to make an informed choice about treatment.
o People don’t think it enables them to make an informed choice, but rather, about liability. People think they are
signing away their rights- that they can’t complain.
- Jones:
o Giving patients more information to redress the imbalance of knowledge and power in doctor-patient
relationships
- Lesser:
o Whilst the doctor has the skill to diagnose the patient, the patient is the one who can best judge what treatment
to undergo depending on priorities
- Hippocratic oath replaced with the partnership model of decision-making:
o Ultimately the patient’s decision
- DEONTOLOGICAL:
o Respect the patient; has the right to choose what happens to their body- to do this, needs information
- CONSEQUENTIALIST:
o Focus on the better outcomes- more likely to comply with treatment
Criticisms of informed consent:
- What does ‘informed’ mean? The doctor’s conduct of informing the patient or the patient’s state of mind of being
informed? Can the patient only consent after considering all the information?
- How much information does the patient need to be informed and properly consent?
- In practice, difficult for doctors to determine how much information to give in order to avoid liability in negligence
- Complex consent forms discouraging communication between doctors and patients:
o Lack of understanding of lengthy forms- just seen as a formality
o Information overload placing disproportionate emphasis on remote risk- may lead to patients refusing
relatively safe treatment
- Time and cost to disclose every possible risk- spreading scarce NHS resources to lengthy consent procedures
- Reality of consent= meeting between patient and doctor
o Problems:
A treatment often involves a series of decisions- not just a single one- singing consent forms suggests
that it is a one-time event, not a process.
There should be effective treatment during treatment, not just before
Signing consent form gives the impression that patients are bound- but in actuality, they can withdraw
consent at any time- many patients feeling as though them singing a consent form is essentially them
removing their ability to sue the NHS.
Patients do not understand this right to refuse treatment at any point
Consent doesn’t have to be written
- Heywood, Macaskill and Williams:
o Studied patients’ perceptions of the consent process: patients saw the consent process to be non-optional if they
were to receive treatment
o Saw it as a means to an end or something necessary
o Openness and disclosure were not often factors considered when signing the consent form
Why inform patients?
- Valid consent= “given voluntarily by someone who has the capacity to consent, and who understands what the treatment
involves.
- Relatively recent development
o Rise of patient autonomy
o Past- routine not to tell people they have cancer/will die
- Correct the imbalance of power and information? Patients knowing more.
- Only the patient knows what side-effects and risks matter to him or her?
o Doctor can diagnose and recommend treatment, patients decide what they want/ e.g. not getting rid of a breast or
going into surgery. Also dependent on relatives etc
- Better outcomes?
o More likely to adhere to a treatment plan if you’ve chosen it
- Sign of respect?
o Ask them before you do something to someone’s body
o As a subject, not an object
- BUT ambiguity over what ‘informed consent’ means
o Has the patient been informed if the doctor has told the patient a lot of information they don’t understand?
o Has the patient been informed only if the patient has made an informed choice as a result?
Does it require patient understanding?
- AND patients themselves see the consent form as a bureaucratic requirement, not an opportunity for autonomous
decision.
o How patients view the process of giving consent
o Most patients not understanding consent form as them adding to their own autonomy
- Very few patients think the purpose of the consent form is to enable them to make an informed choice about treatment.
o People don’t think it enables them to make an informed choice, but rather, about liability. People think they are
signing away their rights- that they can’t complain.
- Jones:
o Giving patients more information to redress the imbalance of knowledge and power in doctor-patient
relationships
- Lesser:
o Whilst the doctor has the skill to diagnose the patient, the patient is the one who can best judge what treatment
to undergo depending on priorities
- Hippocratic oath replaced with the partnership model of decision-making:
o Ultimately the patient’s decision
- DEONTOLOGICAL:
o Respect the patient; has the right to choose what happens to their body- to do this, needs information
- CONSEQUENTIALIST:
o Focus on the better outcomes- more likely to comply with treatment
Criticisms of informed consent:
- What does ‘informed’ mean? The doctor’s conduct of informing the patient or the patient’s state of mind of being
informed? Can the patient only consent after considering all the information?
- How much information does the patient need to be informed and properly consent?
- In practice, difficult for doctors to determine how much information to give in order to avoid liability in negligence
- Complex consent forms discouraging communication between doctors and patients:
o Lack of understanding of lengthy forms- just seen as a formality
o Information overload placing disproportionate emphasis on remote risk- may lead to patients refusing
relatively safe treatment
- Time and cost to disclose every possible risk- spreading scarce NHS resources to lengthy consent procedures
- Reality of consent= meeting between patient and doctor
o Problems:
A treatment often involves a series of decisions- not just a single one- singing consent forms suggests
that it is a one-time event, not a process.
There should be effective treatment during treatment, not just before
Signing consent form gives the impression that patients are bound- but in actuality, they can withdraw
consent at any time- many patients feeling as though them singing a consent form is essentially them
removing their ability to sue the NHS.
Patients do not understand this right to refuse treatment at any point
Consent doesn’t have to be written
- Heywood, Macaskill and Williams:
o Studied patients’ perceptions of the consent process: patients saw the consent process to be non-optional if they
were to receive treatment
o Saw it as a means to an end or something necessary
o Openness and disclosure were not often factors considered when signing the consent form
