Dare we rethink informed consent?

Abstract

Current informed consent practices conform to the informed consent paradigm (ICP). Our intention is finally to promote patient autonomy through the provision of information intended to remove the information (i.e. power) differential between doctor and patient. ICP is fundamentally flawed, since it is impossible to comprehensively and explicitly inform. A fundamental problem is our reliance on the containerconduit metaphor of informing. As a linguistic act, this metaphor conceptualises the process of informing as passive, when in reality informing and consequent sense-making are parts of an individualised, personal and active process. The difficulties of the ICP are discussed, as are possible alternative strategies (reverting to paternalism, retaining the illusion of autonomy, and de-linking informing/consent, or the moral and legal aspects of consent). Alternative models are also discussed (e.g. Manson and O'Neill's notion of informed consent as a transaction). Concluding suggestions include drawing on an ethics of responsibility, incorporating the notion of informed consent as a transaction, debating the issues raised here and promoting the ethical empowerment of practising doctors.

What should I tell my patient? Disclosure in anaesthesiology: difficulties, requirements, guidelines and suggestions

“…A secondary 'paradigm' informs current conceptions of the power relationships that operate in the normal doctor-patient interaction. 1 This model describes the knowledge asymmetry between patient and professional as the root cause of a concomitant power differential. Consequently, patient autonomy is negated in favour of some form of paternalism.…”

“…Unfortunately to do this authentically and not just in name implies high and probably impossible demands regarding the explicitness and comprehensiveness of disclosure. 1 The question is to what extent we actually promote autonomy in the usual doctor-patient IC interaction if we accept that comprehensive and explicit disclosure is necessary, yet impossible. It may be contra-productive to focus too much of our attention on this conundrum.…”

“…(4) The transmission of information is an active process as opposed to the passive model formerly described by the container-conduit metaphor of transfer. 1 This metaphor implied that informing is as simple as pouring fluid from one vessel to another. Patients as recipients of information need time to unpack and process what they read or hear from the anaesthesiologist.…”

Human guinea pigs? The ethics of undergraduate and postgraduate student involvement in medical training in South Africa

“…Yet providing sufficient contextual information leading to authentic IC for all examinations, diagnostic and therapeutic procedures and treatments may be problematic and insufficient. [2] Clinicians are aware that informing patients explicitly and comprehensively is impossible, hence the argument that we should 'rethink' the principles and practice of IC. [2] The knowledge/power asymmetry may lead to therapeutic misconception.…”

“…[2] Clinicians are aware that informing patients explicitly and comprehensively is impossible, hence the argument that we should 'rethink' the principles and practice of IC. [2] The knowledge/power asymmetry may lead to therapeutic misconception. [3] Patients who are simultaneously clinical research subjects may misconceive the nature of research-associated treatments and misunderstand the nature of clinical research.…”