Is Informed Consent Still Central to Medical Ethics?
The debate surrounding informed consent, whether or not it is relevant, revolves around difficulties of implementation. Is it possible for patients to truly make an informed decision regarding medical decisions? In addition, what role should the medical professional play in the decision-making process?
Robert M. Arnold, MD and Professor Charles W. Lidz argue that informed consent is still very much relevant in today’s clinical settings. They believe informed consent helps foster open communication between medical professionals and patients, in addition to contributing to patient autonomy. However, they acknowledge difficulties in implementation. Robert M. Veatch, on the other hand, argues against the necessity of informed consent continuing to play a pivotal role in medical ethics. He believes a more effective system can be developed to address issues currently being addressed by informed consent. In his view, informed consent is no longer adequate in a world in which medical procedures are becoming ever more varied and complex. A new, more holistic approach is needed.
Arnold and Lidz support their argument for the continued need for informed consent by discussing its origins in legal and philosophic circles in the 1960s and refuting arguments against informed consent such as “consent cannot be truly ‘informed'” and “patients do not wish to be involved in decision making.” They refute these claims by stating that, while thoroughly educating a patient on all available treatment options may not possible, it is not an excuse for unilateral decision-making by medical personnel. In addition, they argue that, while it may be true not all patients seek an active role in decision-making, most patients want more information than they are given. They continue with a discussion of informed consent as practiced in clinical settings. In their opinion, different clinical settings require different clinical approaches to informed consent. Veatch, however, bases his position on the premise that informed consent continues to be grounded in the outdated “best interest” view of medical ethics. Essentially, he argues that, while medical professionals inform patients, their personal views and opinions color the information given to patients. If the values of the physician differ greatly from that of the patient, the patient may be discouraged from selecting the appropriate treatment from his/her point of view. Veatch advocates a new approach to patient education and decision-making. This approach centers on pairing patients with medical professionals whose values/beliefs are similar.
Key terms to understanding these texts include informed consent, pro forma approach to informed consent, dialogical approach to informed consent, and deep values.
Informed consent requires a patient to make a decision regarding medical care based on thorough knowledge of viable alternatives. It can take the form of a legal document that must be signed by the patient prior to treatment. The pro forma approach to informed consent is based on an event and assumes all necessary information is obtained at one time. It is useful in describing the approach used towards informed consent in emergency type situations. The dialogical approach, on the other hand, assumes information necessary to give informed consent is exchanged in a series of short conversations. This approach is more useful on a daily basis. Deep values, as discussed by Veatch, are normally based on fundamental worldviews. He states that our healthcare system is beginning to organize itself around deep values. Examples include feminist and holistic health centers.