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Informed Consent Revisited

Published online by Cambridge University Press:  29 July 2009

Amnon Goldworth
Amnon Goldworth
Affiliation:
A philosopher and Visiting Scholar at the Center for Biomedical Ethics, Stanford University, Stanford, California.
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Extract

More than three decades after its introduction as a legal requirement for medical treatment in the clinical setting, informed consent continues to be viewed with skepticism as to its need or effectiveness. Some maintain that it is not required because the ordinary individual believes that doctors can be trusted to behave In the best interests of their patients. This issue will be discussed in a later portion of this article. Others are persuaded that informed consent is an unattainable ideal given the limited capacity of the ordinary individual to understand the relevant information. This view is supported by studies intended to show that satisfactory understanding on the part of patients cannot be achieved. In rebuttal, Apple-baum, Lidz, and Meisel observed that:

Such statements are easily refuted by reference to studies of situations in which reasonable comprehension actually has been achieved. A sounder interpretation of all these studies might be that patients and subjects can attain a good level of understanding in many cases, but that several factors — including the manner in which disclosure is made as well as patients' limitations — may get in the way.

Type
Special Section: Issues in Consent
Information
Cambridge Quarterly of Healthcare Ethics , Volume 5 , Issue 2 , Spring 1996 , pp. 214 - 220
Copyright
Copyright © Cambridge University Press 1996

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References

Notes

1. This article is based on an article, Standards of disclosure in informed consent. In:Goldworth, A, Silverman, W, Stevenson, DK, Young, EWD, Eds. Ethics and Perinatology: Issues and Perspectives. Oxford: Oxford University Press, 1995.Google Scholar

2. Applebaum, PS,Lidz, CW, Meisel, A. Informed Consent: Legal Theory and Clinical Practice. New York: Oxford University Press, 1987:139.Google Scholar

3. Although we distinguish between patients, research subjects and surrogates, I will, for simplicity's sake, refer mainly to patients.

4. Schloendorff v. Society of New York Hospital. N.Y. Supreme Court. 1914;211:129–30.Google Scholar

5. Salgo v. Leland Stanford Jr. University Board of Trustees. 317 p 2d 170 (Cal. App. 1957).

6. Natanson v. Kline. Pacific Reporter 1960; 350: 1106.

7. Canterbury v. Spence. 464 F 2d 772 (U.S. App. D.C. 1972:787).

8. In the case of proxy consent, it is assumed that the surrogate acts in the best interest of the incompetent patient.

9. For Canadian policy, see Gilmore, A. The nature of informed consent. Canadian Medical Association Journal 1985;132:1198–1203.Google ScholarPubMed

10. Mason, JK. Medico-Legal Aspects of Reproduction and Parenthood. Hants, New Hampshire: Dartmouth Publishing Co., 1990:80.Google Scholar

11. Shaw, J. Informed consent: a German lesson. International and Comparative Law Quarterly 1986;35:864–90CrossRefGoogle ScholarPubMed. The subjective standard has also had some application in the United States since the Oklhoma Supreme Court decision in Scott v. Bradford (1979). See Mazur, VJ. Why the goals of informed consent are not realized. Journal of General Internal Medicine 1988;3:370–9.CrossRefGoogle Scholar

12. See note 2. Applebaum, et al. 1987:232.Google Scholar

13. See note 7. Canterbury v. Spence. 1972: 783.

14. Faden, RR, Beauchamp T. A History and Theory of Informed Consent. New York: Oxford University Press, 1986:31.Google Scholar

15. For additional criticisms of the professional practice and reasonable person standards, see Brody, H. Transparency: informed consent in primary care. Hastings Center Report 1989;Sep/Oct: 5–9.Google Scholar

16. Relman, AS. What market values are doing to medicine. The Atlantic Monthly 1992:99–106.Google Scholar

17. Hilfiker, D. A doctor's view of modern medicine. New York Times Magazine 1986;02 23:46.Google Scholar

18. Stevenson, DK, Goldworth, A. The appropriateness of intensive care application. In: Stevenson, DK, Sunshine, P, Eds. Fetal and Neonatal Brain Injury: Mechanism, Management and the Risks of Practice. Toronto: B.C. Decker Inc., 1989:264–72.Google Scholar