Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-06-02T10:47:05.070Z Has data issue: false hasContentIssue false

8 - The value and practical limits of informed consent

Published online by Cambridge University Press:  08 August 2009

By
Merle Spriggs
Edited by
Steve Clarke  and
Justin Oakley
Merle Spriggs
Affiliation:
Murdoch Childrens Research Institute, Parkville, Australia
Steve Clarke
Affiliation:
University of Oxford and Charles Sturt University, New South Wales
Justin Oakley
Affiliation:
Monash University, Victoria
Get access

Summary

Introduction

Obtaining informed consent from patients and research subjects is often seen as an impossible goal. Practical difficulties abound in the disclosure of information, the processing of information and with patient understanding of information. Some people view these practical difficulties as limitations of informed consent. These difficulties and perceived limitations are some of the objections appealed to when it is suggested that patients offered surgery should have access to information about individual clinicians' performance (Clarke, this volume; Clarke and Oakley, 2004). In this chapter I outline the requirements for informed consent and comment on the moral authority of informed consent. I then outline recent influential criticisms of informed consent by Onora O'Neill and Carl Schneider and assess the main practical limitations these authors identify. Based on this assessment, I argue that the practical difficulties can be dealt with – they do not rule out the possibility of informed consent. Instead of practical difficulties, major impediments to achieving informed consent are the result of a failure to adequately value patient autonomy (the value underlying informed consent) and relying on an impoverished or underdeveloped view of autonomy. I argue that a proper understanding of informed consent and patient autonomy clarifies the ethical obligations of health care professionals. A proper understanding of informed consent and patient autonomy also shows us that there is an ethical obligation to provide information about individual clinicians' ability to perform an intervention. I conclude by considering the effect on the doctor–patient relationship of providing information about clinician performance.

Type
Chapter
Information
Informed Consent and Clinician Accountability
The Ethics of Report Cards on Surgeon Performance
 , pp. 134 - 146
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beauchamp, T. and Childress, J. (2001). Principles of Biomedical Ethics, 5th edn. New York: Oxford University Press.Google Scholar
Braithwaite, J., Healy, J. and Dwan, K. (2005). The Governance of Health Safety and Quality, Commonwealth of Australia. Available at http://www.safetyandquality.org/governance0705.pdf (Accessed 4 November 2005).
Carling, A. (1998). Exploitation. In Encyclopedia of Applied Ethics, Volume 2, ed. Chadwick, R.Academic Press, pp. 219–32.Google Scholar
Carvel, J. (2005). More than 1 m patients fall victim to mistakes in NHS hospitals. The Guardian, 3 November. Available at http://www.guardian.co.uk/uk_news/story/0,3604,1607108,00.html (Accessed 4 November 2005).
Christman, J. (1991). Autonomy and personal history. Canadian Journal of Philosophy, 21, 1–24.CrossRefGoogle Scholar
Clarke, S. and Oakley, J. (2004). Informed consent and surgeons' performance. Journal of Medicine and Philosophy, 29, 11–35.CrossRefGoogle ScholarPubMed
Cresswell, C. (2005). Drugged up doctors. The Weekend Australian, 1–2 October, p. 5.
Dworkin, G. (1988). The Theory and Practice of Autonomy. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Faden, R. R. and Beauchamp, T. L. (1986). A History and Theory of Informed Consent. New York: Oxford University Press.Google Scholar
Gawande, A. (2002). Complications: A Surgeon's Notes on an Imperfect Science. New York: Picador.Google Scholar
Gilovich, T., Griffin, D. and Kahneman, D. (2002). Heuristics and Biases: The Psychology of Intuitive Judgment. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Hobgood, C., Tamayo-Sarver, J., Elms, A. and Weiner, B. (2005). Parental preferences for error disclosure, reporting, and legal action after medical error in the care of their children. Pediatrics, 116, 1276–86.CrossRefGoogle ScholarPubMed
Jimison, H. and Sher, P. (2000). Advances in presenting health information to patients. In Decision Making in Health Care: Theory, Psychology and Applications, ed. Chapman, G. and Sonnenberg, F.. Cambridge: Cambridge University Press, pp. 335–61.Google Scholar
Katz, J. (1984). The Silent World of Doctor and Patient. London: Collier, Macmillan Publishers.Google Scholar
Kluge, E. (1999). Informed consent in a different key: physicians' practice profiles and the patient's right to know. Canadian Medical Association Journal, 160, 1321–2.Google Scholar
Lloyd, A., Hayes, P., Bell, P. R. F. and Naylor, A. R. (2001). The role of risk and benefit perception in informed consent for surgery. Medical Decision Making, 21, 141–9.CrossRefGoogle ScholarPubMed
Maher, S. (2005). Surgeon does drug rehab program away from spotlight. The Weekend Australian. 1–2 October, p. 11.
Mele, A. (1995). Autonomous Agents: From Self-Control to Autonomy. Oxford: Oxford University Press.Google Scholar
Meyers, D. T. (1989). Self, Society and Personal Choice. New York: Columbia University Press.Google Scholar
Nader, C. (2005). Doctors ‘operate without skill checks’. The Age, 29 September, p. 7.
NHMRC (2004a). Communicating With Patients: Advice for Medical Practitioners. Commonwealth of Australia. Available at: http://www7.health.gov.au/nhmrc/ publications/_files/e58.pdf (Accessed 4 October 2005).
NHMRC (2004b). General Guidelines for Medical Practitioners on Providing Information to Patients. Commonwealth of Australia. Available at: http://www7.health.gov.au/nhmrc/publications/synopses/e57syn.htm (Accessed 4 October 2005).
O'Neill, O. (2003). Some limits of informed consent. Journal of Medical Ethics, 29, 4–7.CrossRefGoogle ScholarPubMed
O'Neill, O. (2005). Informed consent and public health. SARS conference, Royal Society.CrossRef
Santen, S., Hemphill, R., Spanier, C. and Fletcher, N. (2005). ‘Sorry, it's my first time!’ Will patients consent to medical students learning procedures?Medical Education, 39, 365–9.CrossRefGoogle ScholarPubMed
Schneider, C. E. (1998). The Practice of Autonomy: Patients, Doctors, and Medical Decisions. New York: Oxford University Press.Google Scholar
Schneider, C. E. (2005). Reaching disclosure. Hastings Center Report, 35, 12–13.CrossRefGoogle ScholarPubMed
Spriggs, M. (2005). Autonomy and Patients' Decisions. Maryland: Lexington Books.Google Scholar
Wertheimer, A. (1996). Exploitation. New Jersey: Princeton University Press.Google Scholar
Wilkinson, T. M. (2001). Research, informed consent, and the limits of disclosure. Bioethics, 15, 341–63.Google ScholarPubMed
Williamson, C. (2005). Withholding policies from patients restricts their autonomy. British Medical Journal, 331, 1078–80.CrossRefGoogle ScholarPubMed
Young, R. (1986). Personal Autonomy: Beyond Negative and Positive Liberty. London: Croom Helm.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×