The Limits of Informed Consent for an Overwhelmed Patient: Clinicians' Role in Protecting Patients and Preventing Overwhelm.
In this paper, we examine the limits of informed consent with particular focus on ways in which various factors can overwhelm decision-making capacity. We introduce overwhelm as a phenomenon commonly experienced by patients in clinical settings and distinguish between emotional overwhelm and informational overload. We argue that in these situations, a clinician's primary duty is prevention of harm and suggest ways in which clinicians can discharge this obligation. To illustrate our argument, we consider the clinical application of genetic sequencing testing, which involves scientific and technical information that can compromise the understanding and decisional capacity of most patients. Finally, we consider and rebut objections that this could lead to paternalism.
Member of the professional staff of the Department of Bioethics at the Cleveland Clinic in Cleveland, Ohio.
Johan
J
Bester
Professional staff as a regional bioethicist in the Department of Bioethics at the Cleveland Clinic in Cleveland, Ohio, and the acting ethics liaison for Cleveland Clinic's Genomic Medicine Institute.
Cristie M
CM
Cole
Inaugural director of Cleveland Clinic's Center for Ethics, Humanities and Spiritual Care in Cleveland, Ohio, where he also serves as the F. J. O'Neill Professor and chairman of the Department of Bioethics, and the executive director of the Cleveland Fellowship in Advanced Bioethics and a professor of pediatrics at the Lerner College of Medicine of Case Western Reserve University.
Eric
E
Kodish
D026686:Beneficence; D032882:Comprehension; D003657:Decision Making; D004644:Emotions; D004992:Ethics, Medical; D005820:Genetic Testing; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000523:psychology; D026706:Paternalism; D010358:Patient Participation / Q000523:psychology; D010361:Patients / Q000523:psychology; D010819:Physician's Role; D010817:Physician-Patient Relations / Q000941:ethics; D013315:Stress, Psychological