Tag Archives: doctors

(Mis) Informed Consent: A Doctor’s Perspective

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Prior to having read some of assigned essays on informed consent, I believed it to be a relatively cut and dry issue. Many of the articles or videos that I have reviewed on informed consent seem for the most part repetitive. Informed consent is important—a good thing. Without policies that detail protocol doctors must follow in regards to their treatment of patients, who knows how a patient may be taken advantage of? After all “doctor knows best”; if the law does not stand to protect the rights of patient, who will? Should a patient be of sound mind and of age, they should be given full disclosure regarding the purpose of a medical procedure, the risks and benefits, probability of risk as well as alternatives to treatment (Brody, 283).  I am not a doctor and thus am only able to see things from the patient’s side of the informed consent debate. It seems simple, really. For a physician to balk at the idea of thoroughly briefing and obtaining permission regarding what happens to their patients’ bodies is ridiculous, right?

If informed consent is so great, though, why do so many physicians see it in many cases as unnecessary or frivolous? In the process of searching for interesting essays or articles on informed consent from a physician’s perspective, I stumbled upon a brief opinion piece by John Kelly IV, an MD who is a regular writer for Outpatient Surgery Magazine. Although the opinion was humorous, I think it did a decent job of shedding light onto the ways in which informed consent may be good in theory, but not in practice. Two of the problems that he focuses on in particular are “nitpicking” and “catastrophizing” (Kelly). The consent form is a legal document and of course important; however, how explicit do they really need to be? It is one thing to list possible risks for a certain procedure—that is for the patient’s benefit. But how detailed does a doctor need to be in describing a surgery that is a part of their daily routine? Forcing doctors to stress and go back over every word in a consent form is a waste of time and if anything, could cause them to lose respect for and patience in the process of informed consent.

The major issue that doctors seem to be concerned about when it comes to informed consent based upon my and other students’ posts seems to be “catastrophizing”: the idea that being too explicit in the risks of procedures, some of which are incredibly low, can lead to discouraging patients to receive the treatment and care that is essential to their health (Kelly). How much information is too much?

I am not at all saying that the cons of informed consent outweigh autonomy, which is the moral issue at the center of the argument. I do, however, believe that there should be a movement to standardize policy across states to make the issue a little less hazy for all involved as well as help to maximize the use of doctors’ time.  Solutions that I can think of include an official electronic database on which the risks of various standard procedures are outlined so that patients can clearly view the costs and benefits prior to giving consent. Another option would be to hire hospital staff or train current staff to specialize in patient relations; people who can to sit down with individuals and talk them through the risks and alternatives, as well as their doctor’s recommendations.  I am not sure what other solutions have been proposed or initiated; but until a larger solution is settled upon, the autonomy of the patient will continue to trump physician convenience and efficiency, and rightly so.

Citations:

Brody, Baruch A., and H. Tristram. Engelhardt. “Adult Patients: General Issues.” Bioethics: Readings Cases. Englewood Cliffs N.J: Prentice-Hall, 1987. 282-86. Print.

Kelly, John, IV. “Cutting Remarks: (Mis) Informed Consent.” Outpatient Surgery Magazine. N.p., Feb. 2014. Web. 17 Feb. 2014. <http://www.outpatientsurgery.net/outpatient-surgery-news-and-trends/humor-and-jokes/cutting-remarks-mis-informed-consent–02-14>.

Fear of the Law

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The Canterbury v. Spence case brings our attention to the ethical issues of risk disclosure of a medical procedure. This type of case involves and compares the importance of several pillars of ethics: autonomy, benevolence and malevolence. There seems to be a question that is very difficult to answer, and may differ on a case-to-case basis: Does, “every human being of adult years and sound mind has a right to determine what shall be done with his own body…” (an issue of autonomy) trump a doctor acting in the patient’s best interest and avoiding harm to the patient (benevolence/malevolence)? (https://ereserves.library.emory.edu/reservesViewer.php?reserve=563719) It’s convenient to believe that the legal system keeps people on a moral path and helps people make decisions that are ethically sound and in the best interest of society as a whole. But in some cases, fear of the law may cause more issues than it does good.

Risk of a procedure is not the only type of information that doctors potentially keep from their patients. There is also the issue of disclosing errors that may have occurred during the process of a patient’s care. According to an article in Ghana Medical Journal (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/) doctors often do not tell patients or their families when an error has occurred, whether it be in surgery or anything else related to the patient’s health care. Instead, the doctors and institutions tend to try and cover up these events to avoid legal issues. In this case, the doctors are putting their own well being above that of their patients. According to the report, healthcare errors lead to more deaths than motor vehicle accidents, breast cancer or AIDS in the US. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/).

Putting your life, or the life of a loved one in the hands of a human, capable of error, is an act of immense trust. The article refers to the doctor-patient relationship as fiduciary; “one who owes to another the duties of good faith, trust, confidence and candour”. This is trusting the doctor to act in best interest of the patient. However, can a doctor do that if he is worried about the consequences of an error? If he puts his own well being before that of the patient’s?

In class, we have talked about the importance of intention in ethics. When it comes to health care and medicine, if someone’s life is at stake, people tend to care less about intention and more about the outcome. If an error results in a patient’s death, the family cares little about the doctor’s intention to do good, the focus is on the error that resulted in death. This is the responsibility and punishment that the doctor must shoulder as a casualty of his daily work.

Here we have two different types of disclosure: risk disclosure before a procedure, and disclosure of any errors after a procedure. For the first, the law helps to encourage doctors to share all possible complications with the patient, to avoid lawsuits should anything go wrong. For the second, the threat of the law dissuades doctors from disclosing human error events that may have occurred. This would lead us to the assumption that doctors’ morals are rooted in fear of the law rather then intrinsic human nature.

However, this is not always the case. Like in the Canterbury v. Spence case, doctors sometimes choose to not share some information that they believe may do more harm then good. They take the risk of the potential lawsuit in their effort to do what they believe is best for the patient. In this case, the doctor is putting the patient’s well being above his own. So which is more important, the patient’s autonomy or the doctor’s duty to do what he feels is best for the patient?

 

Citations

Edwin AK. Non-disclosure of medical errors an egregious violation of ethical principles. Ghana Med J. 2009;43(1):34–9. [PMC free article] [PubMed] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/?report=classic

Informed Consent: Opinion Canterbury v Spence https://ereserves.library.emory.edu/reservesViewer.php?reserve=563719 Physicians’ obligations and patients’ rights.