Informed consent in theory and practice: legal and medical perspectives on the informed consent doctrine and a proposed reconceptualization.
The theoretical, legal, and medical doctrines of informed consent are analyzed. The elements of informed consent include disclosure of information, competency, understanding, voluntariness, and decision-making. The doctrine is ground in deference to individual autonomy and recognition that the exercise of self-determination in matters of health is a liberty interest honored by our history and traditions. The exceptions to informed consent including emergency, incompetency, therapeutic privilege, and waiver are especially important in critically ill patients and reflect a balancing of autonomy values and society's interest in the promotion of health. Legal decisions inevitably are based on atypical physician-patient encounters and focus on a particular problem or procedure rather than on overall medical care. In addition, they often reflect an artificial view of the doctor-patient relationship. Medical decision-making is a complex, evolving pursuit of a diagnosis and proper treatment regimen. Moreover, patients are not always interested in the role assigned to them by law. A reconceptualization of informed consent doctrines utilizing sliding scale standards based on variables pertinent to each individual patient is suggested.
Sprung
C L
CL
Department of Medicine, Veterans Administration Medical Center, University of Miami School of Medicine, FL.
Winick
B J
BJ
D032882:Comprehension; D032962:Consent Forms; D003657:Decision Making; D030881:Disclosure; D004630:Emergencies; D006806:Human Rights / Q000331:legislation & jurisprudence*; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D026684:Personal Autonomy; D018570:Risk Assessment; D014342:Truth Disclosure; D014481:United States