Informed Consent

The concept of informed consent is the keystone of medical ethics today. The word “informed” refers to the patient’s understanding of a procedure or treatment, meaning that the patient has been fully informed as to the pros and cons of a proposed method of treatment. Therefore, the patient is able to give or refuse consent based on full knowledge of the risks and benefits of a particular treatment or procedure. Technically, consent by the patient is required once the patient walks through the front door. Hospitals, ERs, and many other providers solve this by having the patient sign a general consent form upon arrival. This will cover all treatment up to anything invasive. Smaller offices use a concept of implied consent. For example, a patient entering a doctor’s office for a sore throat will expect a throat examination. A separate consent is not required.

The problem is in today’s environment of rushed medical visits and high volumes of patients waiting to see the doctor, informed consent may fall by the wayside. Patients can feel “not listened to” and hurried without having their questions answered. This is especially true when you look at the standards of informed consent as developed by medical societies, state boards, and state legislatures. One of the central tenets of informed consent, especially as it applies to operative procedures, is that the person most fully informed about and experienced with doing the procedure should be the person actually performing the procedure. And, just as importantly, consent from the patient should obtained outside of the OR setting and before any anesthesia is administered. This means that the surgeon him(her)self should obtain the consent prior to beginning the procedure, and the patient should have every opportunity to ask any questions and be fully aware of the risks and benefits of the proposed procedure.

Unfortunately, this rarely happens. Consent is often obtained in the OR after the induction of anesthesia, and often by a resident or nurse. Operating on a patient without consent or with improper consent can legally be deemed assault and battery. Many ethics experts are amazed that people are quite content to have substances and devices put in or taken out of their bodies without ever asking the most important question, namely “Why and will it do any harm?” Ultimately, it is or should be the patient who decides what should or should not be done and the competent patient has the absolute right to refuse treatment, even if refusal will mean death.

The same concepts of informed consent apply to medication use. An unfortunate fact is that for many of us, aging means the usage of more and more medications. The (mis)use of multiple medications is called polypharmacy. This is when it becomes important that the patient and his/her caregiver fully understand the need for each medication, especially as new ones are added, what side effects may occur, and what medications may be discontinued. To enhance this knowledge and also allow the pharmacist to be more involved in supervising medication use to prevent polypharmacy, it is important to obtain all the medications from the same pharmacy. If a mail order pharmacy is involved, be sure that the local pharmacist is aware of these medications.

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