Consent & Disclosure of Medical Risks

Question 1

what was the historical position towards patient consent?

Answer 1

• ‘doctor knows best’ (paternalism)
• Hippocratic Oath encouraged doctors to ‘conceal most things from the patient while you are attending to him’
• Informed by treatment options being limited

Question 2

what is the current position towards patient consent?

Answer 2

• partnership model of decision-making between doctor and patient
• informed consent as a patient’s right
• different to disclosure of information/risks or diagnoses

Question 3

what are the bioethical justifications for informed consent?

Answer 3

• consequentialist - if patients are properly informed of how to act after the treatment, then the best possible outcome would be achieved
• deontological - respect for the patient’s autonomy; we are holders of rights over our own bodies

Question 4

3 criticisms of informed consent (incl 1 academic)

Answer 4

• ambiguous and misleading terminology - does ‘informed’ confer a duty on doctors to inform so far as possible or does it refer to the decision the patient is making with all the knowledge available to them?
• Heywood et al: patients have a misguided perception of the role of consent; most patients think consent was about right to self-determination, rather than right to refusal of treatment.
• just how much information? - is informing to an adequate or absolute standard? - may be taking away resources e.g. GP’s time by asking doctor to explain all procedures

Question 5

2 academics’ views on informed consent

Answer 5

• Jones: the doctor-patient relationship still involves a ‘major imbalance of power’, but this disparity can be resolved by providing patient with the ‘right’ to be given more information
• Lesser: while doctors have knowledge of the possible outcomes of different alternatives presented to a patient, ultimately the only ‘right answer’ as to which treatment should be administers is the one the patient chooses for themselves

Question 6

what is the starting point in negligence regarding informed consent?

Answer 6

• the inadequately informed patient
• doctor-patient relationship as a recognised category of duty
• difficulty lies with standard of care - how much information must be disclosed to be considered sufficient disclosure?