16 pages worth of notes containing lecture notes, summary of academic literature and relevant case law and legislation. Considers arguments in favour and against informed consent. Considers the legal protections to informed consent in reference to patient autonomy. Covers Montgomery case and all ot...
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
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