by Alan Lindemann, M.D.
Before the days of all-eyes-on-HIPPA, many patient/physician discussions centered around informed consent. Today, many patients see informed consent merely as a piece of paper to be signed before surgery. But many patients do not know that informed consent, as defined by the American College and Obstetricians and Gynecologists, is a six-part process, two steps for the patient and four steps for the physician. The bottom line, though, is the patient makes the choice of care and the physician is ethically bound to support the patient’s decision even if the physician believes the patient is making a poor choice.
For patients, informed consent means your physician has explained the purpose, benefits, and potential risks of the treatment options to you. There are two key features to patient informed consent:
- understanding treatment options (comprehension), and
- arriving at a mutually agreeable treatment plan with the physician (voluntariness).
There are four key components to informed consent for physicians:
- physician’s obligation to help patient (beneficence),
- balancing competing interests (justice),
- physician’s obligation to do no harm (non-maleficence), and
- support patient’s self-determination (autonomy).
A key element of informed consent is the patient’s having the final say in whatever the patient’s choice of treatment plan. This means it is the physician’s ethical obligation to support the patient in their choice of treatment plan even if the physician believes a different treatment plan may be preferable.
Hospitals and payers, including Health Maintenance Organizations (HMOs), managed care, Medicare and Medicaid, have greatly eroded patient choice and indeed physician choice by usurping the ability to have the final say as to whether the treatment will be covered or not and by controlling which physicians you may see.
The first informed consent a pregnant woman will make is choosing what doctor to see during her pregnancy. Insurance companies should not have the ability to narrow the list of physicians one may see. It’s quite possible the mother prefers going to a doctor outside the chosen group.
It seems to me that the ethics of autonomy and free choice should not be ignored or eroded for the purpose of large corporations making a profit. My book, Modern Medicine: What You’re Dying to Know, provides information on how patient choice has been taken over by corporate health care.
Any time your physician has to get permission from an insurance company, drug company, Medicare, Medicaid, for procedures, prescriptions, or permission to go to a different physician or hospital, informed consent is violated. It’s not just about signing a form agreeing to a surgery. Patients have a fundamental right to accept or refuse any treatment physicians recommend. Corporate medicine should not be given the authority to deny treatments physicians recommend for patients.
It’s a big job, but consumers need to begin taking back their ethical rights regarding informed consent. Contact your legislators. If only 3 or 30 patients do, nothing will improve. If 3 million or 30 million patients contact their legislators, change will occur.
Illustrations by Tryve Olson.
ACOG. Committee on Ethics. Informed Consent. No. 439, August 2009, reaffirmed 2015. https:www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2009/08/informed-consent