Consent to Medical Treatment
Informed consent is the core principle of modern medical practice.
In some very limited circumstances, care can be provided without consent.
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 will die.
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.