The idea of informed consent has evolved over the years along with changes in medical practice. In the past, medical care was based on paternalism, in which the doctor knew what was best for the patient. Now, medical care has become more patient-centered as reflected in the informed consent forms patients sign before medical procedures. According to the article, informed consent is when the physician is required to obtain the patient’s consent after disclosing relevant information about the treatment (Liz et al, 299). However, does that piece of document really represents its definition or does it simply represent the idea of autonomy?
Although physicians are required to disclose relevant information to patients before obtaining their consent, there are also legal standards as to what information must be disclosed. Legal standards also vary by state. For instance, “New York requires only that the practitioner provide information about reasonable foreseeable risks and alternative treatments, while the new Georgia statute requires disclosure of the nature of the treatment, any several specified risks, the likelihood of success, practical alternatives, and prognosis if treatment is declined” (Schuck, 916-917). States have already designated what physicians must disclose to patients. But does that leave the patient with any real autonomy? What if the patient would rather not be provided with the information? Or what if the patient wanted to be disclosed with all material risks?
Health care has increasingly become a legal matter. Health care providers not only have a moral duty to act in the patient’s interest, but also a legal duty. Physicians may find themselves in a court case if he or she did not follow state standards. In Arato v. Avedon, the court considered a claim made by a deceased pancreatic cancer victim’s widow and children that the physician failed to disclose information concerning the statistical life expectancy of pancreatic cancer patients, which violated their duty to obtain his informed consent. They claimed that if the patient had been properly informed of the high probability of early death, he would not have gone through painful therapies and would have avoided economic losses due to failure to put business and financial affairs into order. The court eventually ruled that there was no rule of law that mandated the disclosure of specific information like statistical life expectancy (Schuck, 917-918). This example makes me question how much influence the state has on informed consent. The law doesn’t always determine what is moral and immoral. When people think of informed consent, they usually talk about doctor-patient relationship. I think it’s important to take into consideration what the law says because it greatly affects people’s actions. In the court case discussed above, the court ruled in favor of the physician but does that mean the patient actually received all the relevant information regarding his condition? Maybe yes, maybe no.
The law plays a big part in medical practice. Not only does it tell physicians what they can and cannot do, it can also shape how people view what is considered informed consent. The law exists to protect the people. But is it too influential? Childress states that “the ideal of autonomy must be distinguished from the conditions for autonomous choice” (309). People can choose who or what to yield to when making decisions. But does real autonomy exists when the state can ultimately decide what kind of information patients can receive? Should the state be determining what is regarded as “important and relevant” information or should that be left up to the patients to decide? Can patients make a real autonomous decision when a third-party can influence what information is given?
Childress, James F. “The Place of Autonomy in Bioethics.” Arguing about bioethics. London: Routledge, 2012. 308-316. Print.
Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx, John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing about bioethics. London: Routledge, 2012. 299-307. Print.
Schuck, Peter. “Rethinking Informed Consent.” The Yale Law Journal 103.4(1994): 899-959. Retrieved from: http://www.jstor.org/stable/pdfplus/797066.pdf?acceptTC=true&acceptTC=true&jpdConfirm=true.
5 thoughts on “Autonomy, Informed Consent, & The Law”
While I think it is valid to question autonomy under the law, I also believe it it necessary for the law to be in place. We can continually question “real” autonomy, asking if the law should play a role – but isn’t it unrealistic to expect that there would be no guideline in place? To some degree I believe with the internet and easy access to information that certain individuals have, it is equally their responsibility to be an informed patient. This does not mean researching all of their medication,etc but to ask the right questions to get the best answers. Furthermore, I think that the law is necessary to create at least some type of basic base line for information. If there were no guidelines in theory, health practitioners would have the option of providing little to no information. If anything, I think the law is an attempt (possibly not successful) to protect autonomy.
I agree with what you have said about the law playing an important role in the decisions of physicians, which it should. A perfect example of this is the case that we discussed earlier in class about the DNR note. By law, even if they verbalize it you are supposed to abide by that note. If you do anything out of line or do something completely opposite from what the patient has requested then you could be sued and be in trouble with the law. Issues that could get in the way of this is simply trying to figure out what the patient really wants. Should they be told certain information if it may cause them to have a heart attack? Also, would that be considered the physicians fault if they did indeed have a heart attack?
I do agree that there is a very thin line to be walked in terms of how much influence the law has in medicine especially in informed consent. I feel as though the law intends to prevent genuine physician malpractice but too often do I think it overestimates the control doctors have over a patient’s condition. Medicine is in no way an exact science and I think a lot of treatments are not as efficacious as people think. Most doctors intend to do the best they can for a patient and sometimes it is not enough to save or cure a patient. Because doctor’s do not have complete control over the outcomes of a treatment or procedure, I like the law should be more lenient than not when it comes to malpractice lawsuits.
Medicine and the patient-physician relationship has always been very complex and in my opinion, slightly askew. Physicians are asked and now required to explain and ensure that the patients understands their disease, the implications, and the possible treatment options. I view this as being ridiculous for you expect the physician who spent 4 years in school and at least 4 more training to make sure that each and every patient understands their disease. Don’t get me wrong, I DONT believe that medicine should paternalistic. However, I do believe that the ownership should be on the patient and not the physician to educated themselves about the disease.
This would eliminate the physician’s fears of getting sued for leaving out “relevant” information or too forcefully pushing for a particular treatment. Nowadays, physicians are overly careful of what they say and how they say it. Physicians are professional experts in the human body, but investors are professional experts in the stock market, and mechanics are professional experts in cars and machines. And yet, there is no legal doctrine requiring them to release all “relevant” information. People take their advice and seek a second opinion if they have any qualms. Thus, I believe that the law is holding medicine to a higher standard which is inevitable negatively altering the medical field and profession.
I completely agree with your statement the the state’s differences in disclosure do not represent true patient autonomy, because certain states are required to provide more information than others. What if the New Yorkers wanted complete disclosure before making any life changing decisions, but the state does not require that; hence, we cannot be sure how the physician would respond. Real autonomy clearly does not exist under laws as such, because a patient is not entirely informed and able to make a well thought-out decision. I agree with the above comments in that putting more emphasis on the patient’s ability to inform his/herself alleviates some of the physician’s controversial responsibilities. However; in many cases patient’s might say they did research but be too lazy to take the time out of their day or just skim articles. So then what happens? What happens if someone consents to something they weren’t provided the physician’s information on, but they based it off of their own lack of thorough research (if even). They can still obviously sue the physician for a lack of information, because by law the physician still holds the responsibility to educate. Unless the law completely changes which is unlikely, physician’s are still going to need to educate patient’s based on their state’s laws, but patient research is always highly recommended.
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