Informed consent is general information distributed to each patient. Despite the efforts made by the consent forms to notify the patient of the risks of the procedure, the content of the forms are often disregarded. The questions then rise with how detailed should the content forms be. Should the debriefing of the dangers of the procedure be mainly done by the doctor or should the information be strictly attached to the form. I believe that there should be a combination of both. The patient should be informed about the severity of their surgery through the form, and the doctor should warn the patient about the basic risks of the procedure. Although not as overlooked as Terms and Conditions, the consent forms do serve a pertinent purpose for both the patient and the doctor. The goal here is to communicate to the patient the general risks of the procedure. However, then the question is what exactly should not be shared? Should the doctor discuss the rare cases that may occur with the procedure or not? I believe that the doctor should try to translate medical terms to lamest terms, but they don’t have to go in depth on rare cases unless it is fitting to their condition. I also think that the time information is conveyed should also be a concern. They should be given enough time to contemplate whether they would like to continue with the procedure or not. The patient and doctor should both be held responsible to effectively communicate with each other their concerns with the treatment. If communication is not present then there will be a disconnect with the information given.

When thinking about how the patient is informed, we must also consider the doctor and patient relationship. Some doctors aren’t personable, but establishing a healthy connection between the doctor and patient is pertinent. When this relationship is formed, it builds trust. Also, the doctor becomes more understanding of how the patient feels generally and about the surgery.  As a result, the doctor would have the patients’ best interests at heart. According to Schumann, establishing a patient doctor relationship has therapeutic purposes and is one of the main goals for a doctor during practice.

As stated in the text by Lidz there were four reasons that patients desired information: “Information of Compliance, Courtesy, Veto, and Decision making”. The reasons are understandable, and the patient has a right to this information. Some patients assume that the doctor simply knows what they’re doing, and will do what is best for them. However, Lidz made a great point that out of respect for the person patients want to be informed. The relationship between the doctor and patient would contribute to the degree of courtesy and amount of information that is disclosed. People are unique and respond differently to information when communicated.  However, the patient must also question the doctor about certain issues they have. They also have a duty to ask the doctor about certain things that would affect them that the doctor may not be as informed about. The decision of the procedure should ultimately be a combination of the doctors expertise and how the patient feels. Quite naturally, there will be things that the patient does not understand about the procedure, but it is the doctor’s duty to inform the patient as much as possible with sufficient information prior to the procedure.

References

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.

Kegley, Jacquelyn Ann K. “Challenges to informed consent” EMBO reports, 2004. 832-836.

Suchman, Anthony L. M.D., Matthews, Dale A., “What Makes the Patient-Doctor Relationship Therapeutic? Exploring the Connexional Dimension of Medical Care”.  American College of Physicians. 1988; 108; 125-130.

In the past decades, the doctrine of informed consent has slowly changed the medical practice form “paternalistic standard” to a more “patient centered” standard of care. Today, the topic of informed consent has become a center of controversy because it hardly remains what its original purpose was. When the idea of patient centered standard was first introduced after the historical case of Canterbury vs. Spence, Judge Robinson based his decision on one key point: “Autonomy rights” in which the patient has a right to participate in the decision making process of his own medical treatment.  In his decision, Robinson specified that the burden to educate the patient is on the physician; prior to any medical procedure, the physician should disclose to the patient, not only the nature of the procedure, but also the associated risks, alternatives treatments and potential benefits of the procedure. Hence, the primary aim of the informed consent was to involve and educate the patient about his own health care, and foster a dialogue between the physician and patient towards future treatment possibilities. However, today, the process of informed consent has lost its educational segment and is merely seen as a  process of signing a legal “release” in case of medical negligence.  This shift in the ideology of the process has caused both the physicians and patients to suffer and has hurt the entire medical profession in a big way.   Over the years, patients have become confused and paranoid about the whole informed consent practice and, ironically, by adding possible negative outcomes on the consents, physicians themselves have educated patients of many more medical liabilities than they were previously aware of. Today, patients feel the victims of the informed consent process, and many have lost respect for the medical field in general.  This is due to the fact that most informed consent processes are there to protect the interests of physicians and surgeons, and hardly any protect the patients and meet the needs of their families.

In order to regain the true essence of the informed consent, based on patient-physician trust, Physicians need to provide their patients with the proper information they need to know so that they also understand the possible consequences of their treatments. The ideal decision making process, according to Lidz et, al, should have four elements:  1. Information is disclosed to patients by their physician, 2. Physicians make reasonable efforts to explain the procedure to the patient and make sure that patient understands the procedure completely, 3. Patient makes the decision for or against the procedure, 4. Patient makes the decision willingly. In a New York Times article: Treating Patients as Partners, by Way of Informed Consent,  thttp://www.nytimes.com/2009/07/30/health/30chen.html?pagewanted=all, Dr. Eric D. Kodish,, chairman of bioethics at the Cleveland Clinic, said, “the choreography of informed consent, [is about]  how you make eye contact, sit down, build trust.”  Is it still possible to rebuild this trust based on mutual honesty, for solely ethical and medical reasons?

References

 Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972).

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.

Chen, Pauline. “Treating Patients as Partners, by Way of Informed Consent.” The New York Times. N.p., 30 July 2009. Web. 10 Feb. 2014. <http://www.nytimes.com/2009/07/30/health/30chen.html?pagewanted=all&_r=0>.

“Informed Consent.” Cagle Post RSS. N.p., n.d. Web. 9 Feb. 2014. <http://www.cagle.com/tag/informed-consent/>.

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>

In Holland’s­­ Arguing About Bioethics, within chapter 8 The Case Against Perfection, Sandel discusses the double-edged sword associated with cloning: where, or rather if, to draw a line between medical restoration and genetic enhancement in other situations. Specifically, he focuses on enhancement of muscles, memory, height, and selecting the sex of a child.

To begin with, Sandel reviews genetic therapy involving the restoration and strengthening of muscles. While the idea may have initially stemmed from the need to prevent natural and disease caused muscle deterioration, it is easy to see the potential misuse of the gene therapy in professional sports, giving some athletes and unfair advantage over others without the enhancement by playing God. Huard, an M.S./Ph.D, reasons that while muscle enhancement could be seen as an unfair advantage in a competitive field, muscle and bone enhancement through gene therapy “the potential clinical applications of this technology” lends itself to a multitude usages in the medical field (http://onlinelibrary.wiley.com/doi/10.1002/jgm.344/full#sec1-5).  There are, however, some drawbacks to such an enhancement, leading to a deceased functioning of some hormone glands associated with muscle growth in offspring, seen in mice.

Similar to muscles, memory also focuses on the idea of an unfair advantage sought, whether it be before an exam in school or any other academic situation. Sandel again brings up the idea of an unfair advantage, but instead of focusing on how to level the playing field and enhancing everyone, he asks the reader whether the dehumanizing of mankind should be aspired to. Englbart, however, argues that the “augmenting of human intelligence” is not dehumanizing, but rather a leap along the path of evolution, not dissimilar to humans discovering fire or creating weapons to hunt (http://dougengelbart.org/library/engelbart-archives.html). Through the several articles incorporated, as of yet, there are no known drawbacks or side effects of the memory enhancement therapy, other than playing God.

The argument for height, unlike muscles and memory, has been ongoing for several decades, as the Human Growth Hormone (HGH) has been in use for over half a century. While initially used to aid the growth of children deficient in the hormone, some parents average or even taller children, have requested this hormone pharmaceutically for the extra few inches. Sandel questions why we are building a society in which parents feel “compelled to spend a fortune to make perfectly healthy kids a few inches taller” (Holland 96).  Dr. Gill cites endocrine, ethical, economic, and equity reasoning as to why GH should not be used, explaining that the hormone can lead to diabetes (less than a 2% chance), involves “playing God”, is extremely expensive, and that there are more notable causes to focus on rather than height (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065932/). Overall, if one can privately afford GH treatments, there are no significant repercussions and the needs for cloning to obtain tall offspring is not needed.

Finally, Sandel examines the ethicality of determining a child’s sex through the use of cloning. The arguments surrounding this claim fall parallel to the claims that encompass the abortion debate, should we have the ability to play God and decide who gets to live and who gets aborted?

Throughout Sandel’s various arguments in regards transhumanism, the only point that lacks an infallible counterargument, thus far, is the concept of “playing God” by reworking certain aspects of the human genome on a large scale.

There are several premises associated with playing God.  First, God exists. Second, God is all-powerful and all knowing. Third, humans should not attempt to play God. However, a certain loophole exists within the second premise. If God is indeed all knowing, wouldn’t He know of mankind’s attempt to clone, and then, wouldn’t He prevent this from occurring if it was bad?

Of course there are counter-counterarguments, such as cloning being a test from God, etc. And then another can of worms is opened.

Genetic engineering is undoubtedly a sticky subject, one which raises immediate images of designer children, ultra-athletes or scholars handpicked by their parents to be the best. Most often when we discuss the bioethical nature of genetic engineering, we think of a child’s sex, eye color, height, intelligence. However, we must not forget that a person’s physicality is not the only thing determined by their DNA; many of our behavioral tendencies root from the depths of our genetics as well.

Here is where the question of genetic engineering becomes even trickier to answer: what if we could control for morality in our children? What if human offspring were kinder, more empathetic and compassionate, not because of any lesson taught to them by their parent, but because of a pre-selected genotype predisposing them to these desired qualities? Would this be permissible, or perhaps even obligatory, in modern society?

Faust suggests that as there is a genetic basis to most, if not all, complex human behaviors, especially personality. While environment also has something to say in the development of a child, there is no escaping DNA. With this in mind, she suggests that eventually, it might be possible for couples to select a haplotype predisposing their child to moral behavior: a MoralKinder haplotype (MK+). While this would not guarantee moral behavior in all situations, there would be an increased and statistically significant chance that the child would behave better in most.

Sandel cites many problems with genetic engineering and cloning: lack of autonomy for the individual whose genes are being altered, commodification of human traits, the threat of discrimination in society. It seems, though, that most of these arguments apply to physical genetic engineering. Could we call it dehumanizing if we selected for a haplotype which would increase our children’s humanity? Would the moral problems associated with physical genetic engineering not be at least partially dissolved if genetic moral enhancement were implemented?

Perhaps this issue is not as clear-cut as it seems, though. For some, this seeming increase of humanity appears as a threat to free will and human nature. Sandel points out that what we see as perfecting human nature “threatens to banish our appreciation of life as a gift, and to leave us with nothing to affirm or behold outside our own will” (103). Thus the possibility remains that by attempting to whittle down one end of the behavioral spectrum, humans are narrowing down their natural capacities as opposed to becoming the “masters of nature” (Sandel 103). Additionally, some argue that adding ease to the process of learning morality may devalue it.

However, Faust argues that selecting for MK+ would improve societal morality on the whole and would not remove the free will of the child. A child with a high moral capacity is like a child with a high intelligence quotient; she is not forced to make a certain, arguably better choice, but will certainly be more likely to. And again, a higher IQ does not devalue mathematical or literary abilities in our society; on the contrary, these gifts are praised.

While genetic moral enhancement is still both controversial and fully hypothetical, it provides interesting insight into the direction which genetic engineering might move. Perhaps we can use such an example to look at the ways in which the science of genetic engineering could improve our society, and use this to consider the morality of this issue.

Works Cited

Sandel, Michael J. “The Case Against Perfection: What’s Wrong with Designer Children, Bionic Athletes, and Genetic Engineering.” Arguing About Bioethics. Ed. Stephen Holland. London:   Routledge, 2012. 93-104. Print.

Faust, Halley S. “Should We Select for Genetic Moral Enhancement? A Thought Experiment Using the MoralKinder (MK+) Haplotype – Springer.” Should We Select for Genetic Moral Enhancement? A Thought Experiment Using the MoralKinder (MK+) Haplotype. Springer Science, 01 Dec. 2008. Web. 04 Feb. 2014.