Informed consent is a legal agreement between a health care provider and a patient, in which patients are supposedly given an active role in decision-making processes regarding their course of medical treatment. One element of this doctrine is that patients make their decisions voluntarily, without coercion. What many patients don’t realize, however, is that they are often left in the dark when given information about their course of treatment.
Is true informed consent an oxymoron? If patients were really informed about all the risks of a medication or procedure, how many would consent? Take, for example, this ad for Seroquel XR, an antidepressant. Two thirds of the commercial details side effects. Do patients really pay attention to all of this information?
In Barriers to Informed Consent, Lidz et al. describe the reasons why patients want to be informed of some aspects of their medical situation. Some patients assume that their physicians will do what is best for them and just seek information so they can understand their role in treatment. Others wish to be informed to feel connected to the process or to veto a specific aspect of a physician’s recommendation. There are also some patients who want to play an active role in their treatment process and request information in order to participate in decision-making. These patients are the most discerning health care consumers. Lidz et al. also examine physicians’ attitudes regarding informed consent. Physicians’ knowledge, expertise, research, experience, and the opinions of colleagues go into the medical decision making process. When a physician makes a decision regarding another person’s health, it is assumed that they made the best possible decision for this individual. Therefore, when patients don’t consent to their decisions, they often view this lack of consent as a sacrifice to the patient’s health.
What is not explicitly stated is how physician’s values and religious and political beliefs come into play when discussing informed consent. As mentioned earlier, one facet of the informed consent doctrine requires patients to make their own, independent decisions. However, it is nearly impossible for physicians to give patients a totally unbiased perspective when presenting their options for treatment. Some procedures are extremely controversial, in which case physicians may have strong grounds to dissuade a patient from choosing a specific course of action. Abortion and male circumcision are examples of procedures in which informed consent could become a problem. A physician who is firmly against these procedures is likely to emphasize the health risks and potential for complications. The way that information is expressed to a patient prior to treatment has a significant impact on their decisions. As mentioned earlier, there are varying degrees to which patients want to be involved in their medical situation. When patients are not thoroughly invested, wanting information merely to veto or as a courtesy, they are more likely to be swayed by the physician’s beliefs. Therefore, the informed consent doctrine fails to prevent physician bias from clouding patient’s decision-making ability.
Physician bias also comes into play when physicians favor certain drugs and medical devices due to gifts or other benefits they receive from companies. In an effort to prevent drug companies from wrongly influencing the minds of physicians, the Sunshine Act was recently passed. This act mandates manufacturers of drugs and medical devices in national health care programs to report both monetary and non-monetary items of value that are given to physicians. This information is then posted on a publicly accessible website.
While efforts like the Sunshine Act may help shed light on some factors that influence physicians’ attitudes, the inherent bias due to more personal, fixed beliefs still remains. While certainly useful, the informed consent doctrine fails to take into account the complexities associated with medical decision-making, disregarding the human quality expressed in both physician and patient attitudes that complicate the process.
Works Cited
Charles W. Lidz, Ph.D., Alan Meisel, J.D., Marian Osterweis, Ph.D., Janice L. Holden, R.N., John H. Marx, Ph.D. and Mark R. Munetz, M.D. “Barriers to Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. 93-104. Print.
American Medical Association. “Toolkit for Physician Financial Transparency Reports (Sunshine Act). “ ama-assn.org. Web. 9 Feb. 2014. <http://www.ama-assn.org/ama/pub/advocacy/topics/sunshine-act-and-physician-financial-transparency-reports.page>
The idea of informed consent touches on the aspect of autonomy, in which patients have the autonomy to make decisions for themselves. That’s important to health care providers legally. Morally, people may say it’s wrong for physicians to take complete control of patients. Like what if the patient didn’t want this treatment? That’s why informed consent is important. Even if it’s not real informed consent, it’s the idea of it. I think it’s important for physicians to give unbiased advice to patients. Their advice should solely be based on what is best for the patient medically because everyone is entitled to their own views. A physician shouldn’t purposely prevent someone from certain procedures due to their own values because it’s like they’re attempting to impose their own values on patients. Then the physician isn’t just providing pure information, he’s also including his own values and morals. Any advice that is subjective doesn’t give the patient full autonomy, which is the basis of informed consent.
Regarding your first point, I do not think viewer’s of the antidepressant commercial pay thorough attention to the side-effecs. Most commercials including the one you linked mask the side-effects of the antidepressant by portraying the characters living their happy lives on the medication. The visual aspect of the commercial is extremely distracting to the auditory aspect and that is likely the company’s purpose. On another note regarding physician bias, I completely agree that it is almost unpreventable because everyone has their own personal opinions. An attempt to avoid this is for physicians to encourage patients to take an interest in their procedures and research what is being done. This is difficult to make happen, but provided a patient has done thorough research on their treatment, doctor’s biases will have less of an effect on them.
The role of the pharmaceutical industry in the United States could be an entire class semester on its own, but it definitely has a role in a patient’s “informed consent.” Patients see advertisements like the one mentioned above and think that they know enough about the drug and their own health and request it from their doctor. It is amazing how much doctors will prescribe if they are only asked, and that is not necessarily a good thing. There is certainly such thing as “knowing too much,” especially for someone as emotionally involved as a patient is.
I believe you pose an important point on whether patients really pay attention to the information when given. You also stated, “If patients were really informed about all the risks of a medication or procedure, how many would consent?. Can you truly inform people fully about the risks of the treatment, and how detailed should you be when informing them. It is the physicians duty to care for the patient, so the patient generally expects the physician to choose the most appropriate treatment. However, what role does economics take on these situations when choosing the treatment. The doctor may assign a treatment that may be more expensive and be beneficial for doctor, but not the patient.