Robert M. Veatch’s article argues that informed consent should be abandoned due to its uses as a “transitional concept” and ambiguity (Veatch 317). Veatch provides several examples to support his argument, among these include the “best interest standard”, how a person defines well-being, and physician bias (322-334). All of Veatch’s examples are accurate; with our current health care system it is difficult for physicians to make recommendations or conduct procedures on patients. Two important supporting facts of Veatch’s argument are that “actual consent is not obtained in all cases” and that the concept of informed consent is a relatively recent occurrence (317-318). Patients may also misinterpret the benefits and risks of a procedure (Krumholz 1190). However, in present day Western society I do not think that we would be able to eliminate informed consent. There are too many legal ramifications that could occur which will only require unnecessary spending. In order to find a median between informed consent and the best interest of the patient I suggest that the physician-patient relationship be adapted.
Many of the information against consent were rooted in the physician-patient relationship. American health care does not place great emphasis on time spent with the patient, which does not allow physicians to get to actually know their patients. Many of the issues Veatch present deal with this lack of relationship. This suggests that improving and strengthening the relationship between the two parties would be beneficial for both.
An article by Dr. Harlan M. Krumholz poses a potential solution to improving the consent process. Dr. Krumholz suggests a patient centered approach. Patient centered care focuses on “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (Krumholz 1190). This means that the physician must have a minimal understanding of who their patient actually is. By acknowledging and working with the patient based on their values, many of the issues that Veatch brings up become irrelevant. To improve patient knowledge about procedures and to improve the process of giving consent Krumholz suggests that patients should receive a “brief standardized and personalized informed consent document” that would cover the risks, benefits, alternatives, experience and cost of the procedure (1190). This document can facilitate discussion between physician and patient, and allow the patient to ask more questions and receive the doctor’s opinion. Consent forms will be standardized, and be at an average reading level and reasonable length (Krumholz 1190). Consent forms will not be written by the institution but by experts from the Department of Health and Human Services. One health system in Kansas City has tried out Krumholz’s solution, which led to “improved reading and satisfaction with the consent process, less patient anxiety, and a sense of partnership in the decision-making process” (1190). Krumholz’s solution agrees with one of the last points of Veatch’s article, “the concept of consent will have to be replaced with…active patient participation” (Veatch 327).
This change to patient-centered care could be added to current health care reform. President Obama’s Patient Protection and Affordable Care Act is attempting to improve health care by reducing the amount spent on health care and providing quality care that is affordable (Health Care Reform Timeline). Including active patient participation into the reform (or as a result of it) can also be beneficial. People may take a greater interest in their health, and could be more proactive in maintaining healthy lifestyles.
Sources
Health Care Reform Timeline. http://obamacarefacts.com/health-care-reform-timeline.php
Krumholz, H.M. “Informed Consent to Promote Patient-Centered Care.” JAMA. 303.12 (2010):1190-1191. Web. 24 Feb 2014.
Veatch, R.M. Arguing about Bioethics. Ed. Stephen Holland. Routledge: New York, NY, 2012. Print.
In my opinion, the patient centered care model for consent is unrealistic.
With the current medical system, where doctors are paid by the number of patients that are seen in a day, the incentive to spend long periods of time with a patient are quickly diminishing. Doctors do not have the time to spend an hour or more with a patient discussing different treatment options and the idea of consent if they plan to keep their quotas up to standard.
Many individuals currently are struggling to have access to a regular physician. For those who are attending one time clinics or traveling hours to get care will not be able to have such long conversations about treatment options. Patient education plays a large factor in this decision.
Even for those who are fortunate enough to have a regular doctor, I truly believe that many people would be frustrated spending such a long time at the doctor. In class we continually discuss the importance of understanding treatment, etc but what about the majority of the time when we visit a doctor for something simple and frankly do not care about consent? Would you want to spend a long time being explained every detail? How would the doctor gauge if you truly understood what was being communicated? What if a patient was distracted and misunderstood, or simply was unable to listen?
There seem to be too many questions to realistically expect a change in written consent.
I completely agree with your idea that informed consent needs to be reformed. The patient-physician relationship is not half as personal as it should be in order for a physician to be able to effectively guide a patient through treatment options, etc. The quote: “to improve patient knowledge about procedures and to improve the process of giving consent Krumholz suggests that patients should receive a “brief standardized and personalized informed consent document” that would cover the risks, benefits, alternatives, experience and cost of the procedure (1190)”: seems a little far-fetched, but I support the underlying ideas. There definitely should be brief standardized informed consent forms explaining information from the basics of consent to specific treatments; however, I do not think it is possible for each form to be completely personalized. All of these ideas are technically great, but economically our health-care system is not in the state to propose more expensive alternatives to consent at the given moment. As a whole, I do agree with the idea so maybe we could approach this in a less expensive form? I liked how you mentioned that these forms would be written at an average reading level and an appropriate length in order to be understandable to one with an average education or a short attention span, etc. One of the most intimidating things about consent forms typically is their length and the extensive vocabulary; not typically understood. Making these consent forms more approachable truly does encourage patients to do their reading and optional research.
I agree that in our current health care system it is nearly impossible for physicians to form the kind of relationships with their patients necessary if they want to be able to know what is in the patients best interest. I think that medical schools and doctors are trying to change the physician-patient relationship as you suggested. Student who are pre-med are now being encouraged to take psychology and sociology classes in order to better understand their future patients, their values, and their characters. The shift is to make doctors in the future more relatable and competent in forming meaningful relationships with their patients. I think this will definitely help relationships improve and allow doctors to better understand their patients and thus make better informed decisions regarding the best plan of action. I think this will also push the shift to patient centered care that you suggest.
Thanks for sharing, i like your article and opinion.
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