2017 HSC Section 2 - Practice Management
Vol. 208, No. 4, April 2009
Informed Consent and the Surgeon
Childers et al
Figure 2. Navigating cultural and familial issues during the informed consent encounter.
what a patient says and how a patient behaves should be noted. The surgeon must also secure a private discussion with the patient, during which time the patient is made aware of the informed consent process and his right to it. 22 If the patient does not wish to participate in the traditional “Western” informed consent process, the surgeon should make sure that the patient does wish the family to assume the responsibility of decision-making. In this way, atten- tion is paid to the patient’s wishes, even if autonomy in its truest sense is being subjugated by other cultural values. Finally, the surgeon must ensure that the family itself agrees to make decisions on the patient’s behalf that are congruent with the cultural beliefs of the patient—a difficult task because members within a family may disagree with each other over this issue. 22 In general, individual patient autonomy and the right to fully participate in the informed consent process should be upheld unless the patient explicitly indicates that family members should be included or even be solely responsible in the decision-making process. Although surgeons should not believe that they need to protect patients from their families, physicians should ensure that when a patient de- fers to familial values or interests, the patient has done so willingly. Continuously encouraging patients to be candid about their familial values and interests can allow surgeons to monitor the decision-making dynamic between patient and family. 23 If a patient does seem dissatisfied or pressured by the family dynamic, a private discussion with the patient
(and potentially the family) would be the first step in rede- fining the best interests of the patient. In conclusion, a strong doctor-patient relationship is a critical component to the practice of good medicine. In recent decades, the ethical and legal response to the histor- ically paternalistic doctor-patient relationship that domi- nated the field of medicine for centuries has evolved into the current concept of informed consent. Informed con- sent is best conceptualized as an ongoing process that in- volves both information disclosure and authorization for the procedure in question. The best approach to informed consent combines elements of the subjective and reason- able standards. Specifically, surgeons should learn as much as is reasonably possible about a patient’s values and inter- ests to provide treatment options and goals of care that align with that individual’s interests and values. The sur- geon should strive to disclose information, ensure patient understanding, and facilitate and empower patients to be active participants as decision-makers. When carried out properly, informed consent not only serves to respect pa- tient autonomy but perhaps more importantly, cultivates and solidifies the patient-physician relationship.
REFERENCES 1. Schloendorff v. Society of New York Hospital. 211 NY 125 (1914). 2. Canterbury v. Spence. 464 F2d (1972).
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