Does Informed Consent Really Matter?

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The doctrine of informed consent is a bedrock medical ethical principle.  Physicians’ obligation is to present the patient with reasonable diagnostic or therapeutic options with the respective risks and benefits.  Decision-making authority resides with the patient.  While this process sounds straightforward, it can be a bewildering process for patients and their families.

For starters, physicians – trained medical professionals and members of the imperfect human species – have opinions on which medical options they favor.  These opinions may be on the basis of known medical evidence or their professional experience.  Certain options may not be locally available and might not therefore be given strong consideration.  Do we expect physicians to simply recite a list of options dispassionately?  I don’t think so.  Patients want and are entitled to our best advice.  It is typical for a patient to ask me after hearing the options, “What do you think I should do?”

Patients are not medical professionals. It can be challenging for them to grasp the intricacies and nuances of medical treatment. Imagine a cancer patient – an ordinary person –sorting through 3 different chemotherapy options. This is tough stuff, even though we physicians try to do our best. When my car mechanic or my HVAC pro is offering me various options, do I fully understand the nuances or the choices presented?   There's a reason we regard our safe space as within our comfort zone.

But explaining medical options to patients accurately and fairly is among the highest obligations that we physicians have for our patients.  Yes, it can be a challenging task, but we doctors must strive to meet the moment.  This is not a process that should be approached dismissively or by rote.

The day before I penned this post, I advised a patient with a benign disorder of the esophagus to begin a safe and effective medicine.  The patient understood the rationale for my recommendation and the risks of not treating his condition.  He simply did not want to take medication.  I was satisfied that his decision was informed even though his analysis differed from mine.  But I am not the decision maker.  He is.

My patient's response to my medication recommendation.

With some regularity, patients decline my medical advice for a variety of reasons.  This is not a rejection of me at all, but rather an acceptance of the primacy of the patient’s authority to decide his or her medical future.