Abandoning Informed Consent: An Idea Whose Time Has Not Yet Come

Abstract

In a recent critique of informed consent, Robert Veatch argues that the practice is in principle unable to attain the goals for which it was developed. We argue that Veatch's focus on the theoretical impossibility of determining patients' best interests is misapplied to the practical discipline of medicine, and that he wrongly assumes that the patient-physician communication fails to provide the knowledge needed to insure the patient's best interests. We further argue that Veatch's suggested alternative, value-based patient-professional pairing, is, on his own terms, impossible to implement. Finally, we reexamine the philosophical and practical justifications for informed consent and conclude that the practice should be retained.

Making a difference: incorporating theories of autonomy into models of informed consent

“…Both of these models reflect a focus on the provision of a beneficial outcome whilst attempting to incorporate goals of autonomy within the consent process. In this way the models reflect the inherent tension within the ideals of healthcare to act in the patient’s best (therapeutic) interests and make decisions for them, whilst at the same time, providing healthcare that not only respects but enhances a patient’s ability to contribute autonomously to the healthcare encounter 2 36 37…”

Best Interests, Public Interest, and the Power of the Medical Profession

“…4 ; and how can we possibly presume that doing what is best for an individual is the best thing overall? 5 To the epistemic objection we can give a fairly straightforward response. We need to distinguish between 'theoretical truth' and 'practical truth'.…”

“…This is not to imply that the authors of these articles are arguing the same thing in their respective articles, but merely to highlight the approach taken by Kopelman, whose commitment to the best interests principle and the need for coherence require this sort of reasoning 4. This line of reasoning, relating to claims about epistemic uncertainties can even be aimed at a person's 'knowledge' of what is best for himself[34] 5. For arguments considering how this can play out in a liberal system generally, and principled analysis of the law that might regulate conflicting interests or freedoms, see[2] 6.…”

“…For arguments considering how this can play out in a liberal system generally, and principled analysis of the law that might regulate conflicting interests or freedoms, see[2] 6. Based on the claim in[5], where the authors say that the claim that best interests are unknowable, ''while theoretically true, is practically false …'', p. 482.…”

Withdrawing Nutrition and Hydration from Children: Legal, Ethical, and Professional Issues

“…This responsibility to inform is often described in terms of the duty to elicit informed consent. Truly valid permission for diagnosis and treatment in fact requires discussion of a wide range of issues, including acceptable treatment alternatives and no treatment at all [44][45][46] Recent studies suggest that physicians seldom cover all the ground necessary to elicit genuine informed consent.47 In the context of managing ear infections, ankle sprains, and the like, such failure may be of little consequence-and no doubt stems from some combination of time constraints; familiarity with patients' (or surrogates') beliefs, preferences, and values; and the (perhaps correct) assumption that not all medical decisions demand an equally high standard of disclosure. In the context of deciding whether to provide life-sustaining medical treatment to a severely handicapped child, however, it is unlikely that these allowances pertain-and even less likely they would selectively pertain to the option of withholding nutrition and hydration.…”