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Wednesday, December 2, 2015

Losing Informed Consent

By Paul Burcher
Bioethics Blog
Originally posted November 11, 2015

Here is an excerpt:

This case exemplifies the ambiguity around “informed consent.”  The nurse was referring to a document, a signed piece of paper; I was referencing a conversation, a process involving sharing information and answering questions. From a legal perspective, informed consent would seem to represent the document, whereas from an ethical perspective it is the process, not the paper that embodies informed consent.  Of course, ultimately, both have a role to play, and in the case of a significant procedure it is best to have both sides of this informed consent coin documented.  But what I would like to suggest is that the signed document represents an artifact—a physical symbol that two parties agree that the real nature of informed consent has been fulfilled.  The piece of paper is derivative, and a signed document that lacks the ethical underpinning of a complete and valid consent discussion is meaningless. A lawyer would probably give a slightly different answer, but this is an ethics blog, not a discussion of medical malpractice.

So if the signed document is not an essential aspect of informed consent, but rather evidence of the process that has supposed to have had occurred, what then represents the essential elements of informed consent? The standard answer is really not bad:  all relevant information regarding the procedure, its risks, and alternatives have been discussed, and the patient’s questions have been answered.  But the devil is always in the details, and in this case the detail of importance is how we define relevant.

The entire blog post is here.