The Limits of Informed Consent

The autonomy of the patient has triumphed, in legal terms at least. Doctors and health care personnel are legally required to disclose information about treatments to patients, and patients have the legal right to say “yes” or “no” to any treatment. But how practical is informed consent? The legal implementation of informed consent seems to be mostly a matter of filling out extra paperwork. So that seems practical enough. On the other hand, actually practicing the moral values behind informed consent is much more difficult.

We value the freedom to choose on so many levels. We have a right to choose as consumers, as voters, as citizens and as competent people in general – so then why not as patients? Of course patients should have a right to consider multiple opinions, assess alternative treatments, and then make a choice on their own. But in reality, a patient’s autonomy is highly limited. A lot of the limiting factors are neither inconsequential nor easily avoidable. In Barriers to informed consent, Lidz et al. outline how patient trust, physician expertise, acute illnesses, and complex medical systems make true informed consent difficult to achieve.

Are we morally obligated to try to overcome these obstacles? Or can they be viewed as the practical, real-world limits to our abstract ideals of patient autonomy? This question isn’t really about obstacles like access to healthcare or the complexity of the healthcare system. There’s no question that we should be trying to increase access to care and streamlining the system. The interesting obstacles are those that deal with the doctor-patient relationship. Should we be trying to change this relationship on a moral basis?

Let’s consider patient trust and physician expertise – both important obstacles to informed consent. Patients often don’t really want to make a decision based on what they know about their medical condition. They instead trust the physician enough to make such decisions for them. I see this as a clear act of autonomy. It’s a very rational choice to trust a trained professional’s informed decision over one’s own, likely less-informed decision. Ah but that’s where physicians have to make sure patients are fully and objectively informed, right?  Well even if a physician explains the relevant diagnosis and treatment to the patient in an easily comprehendible way, most patients will not know the essential mechanisms and pathology behind the physician’s decision. They’ll instead be given a simplified picture of a complex system – one that is inevitably going to be biased towards the physician’s decision anyway. We can’t blame physicians for such simplified, biased explanations any more than we can blame scientists for being biased towards one particular theory or paradigm. In the words of Galileo, “it is not within the power of the practitioners of demonstrative sciences to change opinion at will,” (p 125). They are compelled to believe what they believe by the power of reason.

All of this is not to say that the “informed” part of informed consent is irrelevant just because it is likely to have a bias. But maybe the information is, for practical considerations, less important than what we call patient trust – a form of rational consent.


Galilei, Galileo, and Maurice A. Finocchiaro. The Essential Galileo. Indianapolis, IN: Hackett Pub., 2008. Print.

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.

6 thoughts on “The Limits of Informed Consent

  1. Informed consent is basically a process of building trust between the patient and physician via communication. That is why in my initial blog: Informed Consent: It is your pick, I said that the process of informed consent has become a legal formality instead of a process of meeting of two minds, agreeing to one thing. The original purpose of the informed consent as outlined by the court in Canterbury v. Spence was that the process should be considered as a professional duty of a physician to share information with the patient. Initially, the doctor patient relationship was based on the idea that the doctors know the best. However, the rapid changes in the healthcare industry have placed a heavy burden on this relationship. This relationship has evolved; the emphasis has shifted from what physicians normally disclose to what patients wants to know. There is nothing wrong in this ideology. Physicians should not have any problem explaining their concerns to their patients, unless there is a hidden motive in it. Similarly, patients should also trust their providers as their health advocates who will give patients the best care possible. So, to emphasize on what you were saying about “rational consent”, I agree that all the paperwork, and documents are irrelevant and are legal complications. This relationship needs to take a step back and each party has to evaluate what’s in there for me and build a partnership based on mutual gains.

  2. Your blog poses an interesting question about doctor-patient relations: “Should we be trying to change this relationship on a moral basis?” I agree with your point that a patient allowing a physician to make a decision on their behalf is indeed a form of autonomy. Choosing to trust a doctor’s opinion is a matter of one’s autonomy. The implication here is that a patient also has the right to ask for a second opinion or do some medical research of their own. While the average person does not possess the same medical knowledge as a doctor and we can assume that risks and procedural matters are simplified, I think it is safe to say the simplification is not a matter that will drastically affect the patient. So long as the patient knows all of the risks associated with a procedure and possible conditions that make that risk more likely, then any additional knowledge is superfluous. However, this again relies on the patient’s decision to seek knowledge additional to what he/she has already learned from his/her doctor. Seeking additional knowledge is a reasonable choice that should make placing the burden of informed consent entirely on doctors unjust.

  3. You are right that a lot of what physicians say when trying to obtain informed consent goes way over the head of the patients. The average patient has very little medical knowledge and the actual pathology or mechanism of what is going on is likely not understood by them. I had never thought about all the inherent bias in informed consent until the readings and your blog post. Obviously the doctors are going to explain the procedure in a way that makes the patient more likely to make a decision they agree with, whether consciously or subconsciously. Doctors understand the risks and rewards best, and when communicating to their patients they were tend to lean towards the side they believe is best. Is this immoral? Maybe. But I don’t think the bias is something we can change and that it is just an inherent factor of informed consent.

  4. I think you raise a interesting question on whether trusting a physician is an act of autonomy. Trust is difficult to be established when people don’t really know each other. However, since patients are willing to receive medical help from the doctors, they might somehow trust the doctors at least a little. To build up trust, there must be a good communication between physician and patients, which then this communication is how well the physician informs the patients about the procedures and risks of the treatment. Patients of course can do their own research on the treatment that may lead them to trust their doctors more or less. Even that, how do you make sure that patients make the rational decision? It’s impossible to measure that, unless you keep on asking the patients why they make the decisions. To determine that the patients make the rational decisions, the doctors must inform all the common risks, rare risks, procedures, and alternative ways. Giving other treatment options allow the patients to think more, not just yes or no to the treatment, but provide a more comprehensive and thorough thoughts on these treatments.

  5. The practicality of informed consent as you mentioned is a very challenging thing to determine. There is only so much that a patient can determine about which treatment he/she is best suited for. I do think it is very important for a physician to have extensive communication with their patients. To me, the best course of action is for a doctor and patient to go over all treatment options together and have the doctor act as a facilitator for the patient’s care. I do not think the best outcomes result from a doctor simply telling a patient what they will get for treatment with the patient not having any input in the matter. Nevertheless, it is unreasonable for a doctor to tell the patients about every single risk for a treatment as unexpected outcomes can occur without the doctor being at fault. Along these same lines, patients cannot expect to doctors to be perfect.

  6. I love the point you bring out in this issue, which parallels the sentiment that since doctors have to water down medical information in order to explain conditions to patients, the natural choice of language will inherently favor the preferred opinion of the doctor. This bias is very important to consider and I am glad you picked it out because it is easy to stay hidden. What I mean by this is that is seems to solve the problem (the presence of an explanation) but it may defeat the purpose of better informing the patient (if it works to push the doctor’s opinion anway).

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