[On past practices and future directions of informed consent in (radiation) oncology].
OBJECTIVE
Informed consent, especially in oncology, is predominantly seen from a legal point of view. Such a limited perspective runs the risk of reducing informed consent to some tiresome formalism. The present article highlights how the relationship between patient and physician might be enriched by a comprehensive historicocultural understanding of informed consent. The authors show in which future directions the practice of informed consent might develop.


METHODS
Analysis of historical and forensic literature regarding informed consent.


RESULTS
With the terms "information" and "consent" the last 2500 years of medical history can schematically be divided in three epochs: the first epoch started around 500 years BC, lasted until the 19th century AC and was dominated by the principle of "salus aegroti suprema lex". The patient's benefit was exclusively defined by the treating physician. Formal consent was not required in those times. The era of enlightment brought new ideas to Europe, especially the principle of individual autonomy. In 1894, the Supreme Court of the German Reich decided that any medical intervention without the patient's consent was regarded as physical injury and was thus illegal. Systematic requirements regarding patient information on planned medical interventions were not known. The beginning of the third epoch is marked by the introduction of the term "informed consent" in modern medicine in 1957. Since then, a comprehensive information of the patient is seen as a prerequisite for consent. The patient's right of self-determination is attributed a higher legal and moral value than the physician's concept of the proposed treatment. Nowadays, the debate regarding informed consent is dominated by the continuing differentiation of modern medicine, the development of medical practice as part of the service sector, and the changing ways how patients see themselves.


CONCLUSIONS
Social and legal developments have strongly influenced medical practice in the past. The importance of informed consent will continue to rise in the future, while the emphasis of the physician's task will shift from information to counseling. Informed consent will be increasingly established as independent service.
Klinik für Strahlenheilkunde, Universitätsklinikum, Freiburg. lutterba@mst1.ukl.uni-freiburg.de
Johannes
J
Lutterbach
Christian
C
Weissenberger
Klaus
K
Hitzer
Almut
A
Helmes
D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049690:History, Ancient; D006801:Humans; D007258:Informed Consent / Q000266:history*; D009369:Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000266:history / Q000639:trends*