Informed consent is the core principle of modern medical practice.
In some very limited circumstances, care can be provided without
Medical care practitioners must disclose conflicts of interest that might
affect their clinical judgment.
There are special laws governing consent for minors and incompetents.
Patients have the right to refuse medical care, even when it means they
Patients do not have a right to improper care or assisted suicide.
The doctrine of informed consent is the cornerstone of modern medical
jurisprudence. Although the need for bare consent to treatment is old, informed
consent arose after World War II, driven by the Nuremberg Doctrine and the
rise of technological medicine. It has been one of the most misunderstood
principles in medical law, sometimes driving a wedge between patients and
physicians. Now it is returning to its roots in the physician’s fiduciary duty to
the patient, as consent issues shift from concerns about unnecessary or
inappropriate treatments to denial of treatment driven by managed care
organizations’ cost cutting.
This section reviews the history of informed consent and discusses the different
standards governing simple and informed consent. These standards reflect the
conflict between legal ideals of medical care and its reality. Patient advocates
and many physicians view informed consent as a way to empower patients,
thereby making them equal partners in the therapeutic relationship. This is a
naive view of informed consent. Informed consent does not affect the disparity
in power and knowledge between physicians and patients. Informed consent is
very important at the margin, when there are clear, simple-to-understand
choices. It cannot protect patients from overreaching by physicians or from
antiscientific delusions about medical treatments. Good science and proper
standards for medical practice are more empowering than elaborate informed
consent rituals. Informed consent is a laudable goal, but it is possible to
comply with the legal standards for informed consent without effectively
involving the patient in the decision-making process. When this happens,
physicians lose the true value of informed consent: reducing conflicts with
patients through dissipating unreasonable expectations.