Respecting Choice: A Study on Informed Consent and Respect for People’s Choices
A patient being able to have a choice in their well-being is a complicated discussion because of how many factors contribute to it. Informed consent is a term used in the world of health care that means, you have the right to fully understand what a medical professional is using or performing on you. Not only does the choice to know fall under this term but also the right to understand and choose the care being offered to you. Informed consent can be subjective depending on where you stand morally and ethically. Your choice as a person is something that should be taken into consideration, whether it is reinforced is a different discussion.
Informed consent doesn’t have a very long history as there are only 4 judicial decisions that support patients. Most notable was the case of Schloendorff v Society of New York Hospital which was the final landmark in 1914 that made the principle of patient autonomy come to action (Bazzano et al., 2021). Judge Benjamin Cardozo states that “Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who operates without his patient’s consent commits an assault, for which he is liable in damages” (Bazzano et al., 2021). Not following a patient’s choice after this decision was seen as an assault by the medical professional toward the patient as that was now strictly illegal. Although this decision was important, other contributing factors can play into informed consent and more aspects of it to be legalized.
Understanding Treatment
Decision-Making Capabilities
A person must be able to understand what is being given to them or how they are being cared for. Or the person doesn’t know what they are agreeing to. The goal of informed consent is to provide patients with information that they understand, most importantly the risks and benefits of the procedures (Informed consent and shared decision making in obstetrics and Gynecology 2009). Understanding the situation plays a huge role in Informed consent and falls upon the patient and healthcare professional as without complete understanding a patient has no idea what could be injected into their body or what could be lost or gained. Two huge contributing factors that influence a person’s decisions and understanding are a patient’s ability to understand but also a doctor’s job of making sure they understand.
Patients sometimes may not have the ability to make decisions and as a result, make the process of going through procedures longer and tedious. For example, “Meeting the ethical obligations of informed consent requires that an obstetrician–gynecologist gives the patient adequate, accurate, and understandable information and requires that the patient can understand and reason through this information” (Informed consent and shared decision making in obstetrics and gynecology 2009). Although this is important, a doctor’s measurement of understanding shows the same amount of significance as patient understanding.
Social Differences
Gender also plays a role in understanding procedures as studies have shown that there are differences in people’s choices depending on your gender and/or age. In a study among individuals aged 55 years or older women paid more attention to symptoms and understanding of cancer rather than men (Sirri et al., 2012). This study also supported the idea that men believed they shouldn’t seek help and therefore didn’t feel the need to understand their healthcare providers as they would “tough it out”. This responsibility sadly relies on the patient and is a negative result of what men perceive they should act like.
The way that a doctor explains a certain topic may also affect the patient’s understanding of the topic as an empathetic and communicative relationship between patient and doctor shows better adherence to medical procedure (Sirri et al., 2012). This not only affects understanding but also treatment time and benefits the actual health of the patient “In patients undergoing surgery, Egbert et al. Found that the provision of instruction, encouragement, and suggestions by physicians had a beneficial effect on postoperative pain and length of hospital stay” (Sirri et al., 2012). Understanding is a very important aspect of informed consent and decision-making, gender, and empathy can all affect a patient’s choice to consent to medical treatment.
Permission, Example, and Future of Informed Consent
Laws Surrounding Informed Consent
Laws surrounding Informed consent can vary from state to state, however, each state has 3 legal standards that they follow closely:
The required standard for informed consent is determined by the state. The three acceptable legal approaches to adequate informed consent are (1) Subjective standard: What would this patient need to know and understand to make an informed decision? (2) Reasonable patient standard: What would the average patient need to know to be an informed participant in the decision? (3) Reasonable physician standard: What would a typical physician say about this procedure? (Shah et al., Informed consent – statpearls – NCBI bookshelf 2023).
This clearly states that states require the patient to be able to comprehend and be able to make informed decisions.
Another law surrounding informed consent is the requirement of making sure the patient has the age and capacity to make informed decisions. In terms of children, they do not have informed consent as their parents make the decisions rather they have informed permission (Shah et al., Informed consent – statpearls – NCBI bookshelf 2023). Since a child’s brain is underdeveloped, it can be assumed that they cannot make an informed decision. Rather their parents must make this decision for them and consent to it with much caution. The only exception to this is a child who is legally emancipated and can make their own decisions (Shah et al., Informed consent – statpearls – NCBI bookshelf 2023).
Some laws make exceptions to Informed consent as the person may not be able to allow the practitioner consent.According to Parth Shaw in “Informed Consent” it states that “Several exceptions to the requirement for informed consent include (1) the patient is incapacitated, (2) life-threatening emergencies with inadequate time to obtain consent, and (3) voluntary waived consent”. This shows that if a patient is not able to consent and it is a life-threatening emergency then the most ethical choice will be chosen. Also, a patient waving can count as consent if the person is not able to communicate in any other way at the moment. These exceptions are for extreme situations and are drastic ethical choices that are made by medical professionals.
Case Studies of Informed Consent
In the first case, there is a 24-year-old with lacerations to his forearms and he is suitable to try out new suture material, the research assistant brings him an informed consent document for he must sign, he cannot read in any language, and speaks Spanish (Marco, Informed consent for medical research: Case studies 2004). Although informed consent documents were given to the patient, it must be made clear that the patient can understand the documents. Catherina A. Marco states in response to this case “Because of the inherent vulnerability of such patients, special attention should be paid to avoiding coercion of any type and ensuring understanding of the voluntariness of participation” (Marco, Informed consent for medical research: Case studies 2004). This means that although there are language barriers the researcher must make sure he understands what he is signing it was an extremely life-threatening situation.
In the second case, much like the first, there is a 56-year-old woman who has unbearable chest pain and is eligible for new treatment. She is served the informed consent documents and whilst in pain, signs the documents without giving it a second thought (Marco, Informed consent for medical research: Case studies 2004). Informed consent was used wrong in this scenario as the woman was in too much pain and stress to understand the papers she was signing. Catherine A. Marco also states “Specifically, patients should be informed of the voluntary nature of participation and should be assured. that prompt and appropriate medical care will be given, regardless of research participation”. While the patient must understand the research participation it is more important that the patient understands what medicine and or medical procedures will be used on them. These cases show how patients must understand what medicine and medical procedures will be used even if there are language barriers or the patient is under too much stress to make the decision.
The Future of Informed Consent
For the future of Informed Consent, there have been studies done that suggest that shorter and easier-to-read informed consent documents are preferred by patients (Hughes, 2021). This makes the process easier not just for patients but also for medical professionals. Making consent forms online also helps patients better understand and comply, as it is simpler and puts them in a place, they feel most comfortable with (Hughes, 2021). As time goes by informed consent will be a topic that is researched more and more, and hopefully, the information given understood better as well.
From when it first became legal in 1914 informed consent has been a very important topic that requires not just understanding from patients but also understanding from the medical professional as well. Understanding from patients can be affected by a multitude of things including decision-making skills, age, and gender. However, regardless of the situation, the patient’s best interests should be the most important thing considered in informed decision-making. In conclusion, legal frameworks, ethical considerations, and the ever-changing way that information is presented should not undermine the importance of a person’s choice made by informed consent, and moving forward, the right thing to do is always to respect people’s wishes.
