title: How changes in health care practices, systems, and research challenge the practice of informed consent.
abstract: Informed consent has been the central model for ethical decision making in clinical care and research. The goal of informed consent is to protect the right of a competent person to make his or her own health care decisions based on personal values and goals. But changes in health care practices, systems, and research have challenged this well-established goal. This paper examines these changes to show that decisions about care and research directed to individual patients rely more and more upon a population perspective. As a result, efforts to promote patient choice should attend to the ethical decision-making processes of institutions that create and sustain this perspective.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pennsylvania, Alzheimer's Disease Center, Philadelphia, Pennsylvania, USA. jasonkar@mail.med.upenn.edu
authors.forename: Jason H T
authors.initials: JH
authors.lastname: Karlawish
authors.forename: Ellen
authors.initials: E
authors.lastname: Fox
authors.forename: Robert
authors.initials: R
authors.lastname: Pearlman
mesh_terms: D003657:Decision Making; D003695:Delivery of Health Care / Q000592:standards*; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D005610:Freedom; D006805:Human Experimentation; D006801:Humans; D007258:Informed Consent; D008329:Managed Care Programs / Q000592:standards; D009936:Organizational Innovation; D010344:Patient Advocacy; D012106:Research / Q000592:standards*; D014481:United States