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Introduction

The notion that patients have the right to know what is to be done to them and to have some voice in whether it is done has caused more confusion than any other medical legal doctrine. This chapter 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. As discussed in Chapter 10, 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.

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