The dismantling of informed consent is a disaster

David Penner
KevinMD.com
Originally posted September 26, 2018

Informed consent is the cornerstone of medical ethics. And every physician must defend this sacred principle from every form of evil that would seek to dismantle, degrade and debase it. If informed consent is the sun, then privacy, confidentiality, dignity, and trust are planets that go around it. For without informed consent, the descent of health care into amorality is inevitable, and the doctor-patient relationship is doomed to ruination, oblivion, and despair. It is also important to acknowledge the fact that a lack of informed consent has become endemic to our health care system.

This betrayal of patient trust is inextricably linked to three violations: a rape of the body, a rape of the mind and a rape of the soul. The rape of the mind is anchored in a willful nondisclosure of common long-term side effects associated with powerful drugs, such as opioids and certain types of chemotherapy. When a patient starts a chemotherapy regimen, they are typically briefed by a nurse, who proceeds to educate them regarding common short-term side effects such as mouth sores, constipation, and nausea, while failing to mention any of the typical long-term side effects, such as cognitive difficulties and early menopause. It is the long-term side effects that underscore the tragedy of having to resort to chemotherapy, as they can have a devastating impact on a patient’s quality of life, even long after remission has been attained.

The info is here.

Vignette 36: The Cancellation Conundrum

Dr. Wendy Malik operates an independent practice in a suburban area.  She receives a referral from a physician, with whom she has a positive working relationship.  Dr. Malik contacts the patient, completes a phone screening, and sets up an appointment with Mr. Larry David.

As is her practice, Dr. Malik sends a confirmation email, attaching her version of informed consent.  She instructs Mr. David that he does not have to print it out, only review it and they would discuss any questions at the initial appointment.

Several days later, Dr. Malik checks her email.  In it, Mr. David sent her an email with an attachment.  Mr. David asks Dr. Malik to review his edits on the informed consent document.

While Dr. Malik notes some suggested corrections on the document, Mr. David modified the cancellation policy.  Dr. Malik’s form (and standard policy) is appointments cancelled with less than 24-hour notice will be charged to the patient.  Mr. David added a sentence that if Dr. Malik cancels an appointment with less than 24 hours, Mr. David expects Dr. Malik to pay him an amount equal to her hourly rate.

Flustered by this edit, Dr. Malik contacts you for a consultation.

What are the ethical issues involved in this case?

What are the pertinent clinical issues in this case?

How would you help Dr. Malik work through these issues?

Would you recommend Dr. Malik call to address the issue ahead of the appointment or wait for the initial session?

At this point, must Dr. Malik keep Mr. David as a patient?

If not, does Dr. Malik need to contact her referral source about the issue?