What Is Informed Consent?
The medical-legal implications of informed consent are often misunderstood, according to Leigh Sowerby, MD, assistant professor in otolaryngology-head and neck surgery at Western University in London, Ontario, in Canada. “Traditionally, in medicine, we think of informed consent as a piece of paper that the patient signs, but that’s not what informed consent is,” he said. “Informed consent is actually the discussion around surgery and the process by which that piece of paper is signed.”
Dr. Sowerby said the process of obtaining informed consent has four main components, as established in the landmark legal decision Schloendorff v. Society of New York Hospital (1914). According to this decision, to give consent, a patient must understand the following:
1. The nature of the disease or condition;
2. The benefits and the risks of the procedure;
3. The alternatives to the procedure; and
4. The consequences of no action.
Dr. Sowerby acknowledged that it can be tough in busy practice to have a thorough discussion of all of those components with a patient, to the point where you’ve answered his or her concerns. “As an example, we all have our little spiel that we give when we take consent for a specific procedure. … If you’re a patient and you’re hearing that and you hear “heart attack,” and you get stuck on heart attack, you miss all of the other stuff that’s discussed during that consent. And you end up signing the piece of paper because you know you have five or 10 minutes with the physician. But you may not have had all of your concerns addressed, and you definitely don’t remember everything that was discussed.”