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Consent to medical care can be truly voluntary only when it is reasonable to reject the care. Certain religious groups aside, a patient cannot be said to assume the risks of lifesaving care voluntarily. The law recognizes this in its requirement that a patient convince the jury that he or she would have forgone the treatment had the risk in question been made clear. The more clearly necessary a treatment is, the less meaningful is the idea of informed consent. Yet even in life-threatening situations, voluntariness can be an issue if there is more than one appropriate treatment. The patient might not reasonably reject all treatment but may justifiably argue that he or she might have chosen a different treatment.

Voluntariness becomes a legal issue if the physician coerces the patient into accepting a treatment for which there are acceptable alternatives. This coercion may be explicit--telling the patient that he or she will die without the proposed treatment at once--or implicit--ignoring the discussion of alternatives or financial intimidation. Physicians who cooperate with third-party payers to limit patients' treatment options undermine the voluntariness of patient consent. They should not be surprised if a court determines that this renders the patient's informed consent invalid.

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