Informed Consent

10 04 2010

The idea for informed consent resulted from the war crimes committed by many Nazi doctors during the Second World War that were justified at the time as medically relevant experiments on human subjects.  “Those involved in horrible crimes attempted to excuse themselves by arguing that there were no explicit rules governing medical research on human beings in Germany during the period” (Vollman et al 1445).  And as most of those subjects were forced into the experiments, often to their detriment, without any option to object or even know of the greater plans for their bodies, the Nuremberg Code was implemented and is the foundation of what we now call simply informed consent.  In layman’s terms, informed consent is simply allowing a medical professional to treat a patient after the patient has been made aware of options available, yet that is a very simplistic view of informed consent.  “Consent is defined as the voluntary agreement by a person with sufficient mentality to make an intelligent choice about allowing an action proposed by another person … to be performed on himself or herself” (Pape 1122).

“Informed consent should be thought of as a communication process through which a patient, with the advice and support of his or her physician, makes decisions concerning the treatment he or she will receive” (Yale).  Quite often when I visit a medical facility, the informed consent form has been nothing more than a document, thrust into my hand on a clipboard, with an X to mark the spot where I should sign and little discussion is ever given to truly explain what it is I am signing.  Even if I were to try to decipher the legal verbiage, there has typically been a nurse or attendant, anxiously rushing me to move through the formalities so that the doctor may get on with the show.  I was almost relieved to learn I am not alone in feeling uninformed and yet obligated to sign away my consent (Landro).  A patient should feel that they are in control of the decisions being made about their treatment, this is a critical aspect of informed consent and to be able to make that educated decision without the benefit of medical school, the patient has to be able to fully understand the merits and risks of all of their options.

“The bottom line is awareness that the patient smiles at you and nods his or her head doesn’t mean that he or she understands what you said,” says Dr. James Rohack (Barry et al).  One suggestion I found time and again was to avoid using medical terminology or jargon when explaining options to the patient, Sandy Cornett advises to “make every effort to explain …in plain language” when you explain medical procedures to a patient (Cornett).  If the patient is mentally competent and of the legal age, typically 18, to give their consent and we as medical professionals have practised due diligence to explain what options they have and the risks of each of those medical options, then we can know that the patient is giving their informed consent.

There are legal risks if our facility practises on a patient without making certain that the patient is capable of understanding the full details explained to them, understands those details and is legally of age to sign their consent.  For example, a 51 year old man was dying of heart failure and the hospital suggested an opportunity to he and his wife of him receiving an artificial heart.  The patient and his wife heard and believed it to be a medically sound procedure and an opportunity to extend his life, the hospital though was offering an opportunity for the man to be a test subject, the fifth test subject, to test out an artificial heart.  The man later suffered a stroke and was declared brain dead and as a result, his wife sued the hospital, the heart maker, and the representatives who helped inform her and her husband to get consent (Goldberg).  There are several cases similar to this, some less dramatic and some more, but when the life of any patient is at risk, it is always critical that they fully understand all of their options and what is truly being suggested to them to avoid the harm to their life as well as the risk of lawsuits to follow.


Work Cited

Barry-Ipema, Cathy, Dennis O’Leary, James Rohack, and Toni Cordell. Proc. of Joint Commission Conference Call on Health Literacy in America. Joint Commission. Web. 7 Apr. 2010. <http://www.jointcommission.org/NR/rdonlyres/4CB138B1-23D5-408F-9537-123FD81C9B48/0/Health_Literacy_transcript_2707.pdf&gt;.

“The Nuremberg Code (1947).” British Medical Journal 313.7070 (1996): 1448. British Medical Journal. Web. 7 Apr. 2010. <http://www.bmj.com/cgi/content/full/313/7070/1448&gt;.

Cornett, Sandy. “Assessing and Addressing Health Literacy.” Online Journal of Issues in Nursing14.3 (2009). The American Nurses Association, Inc. 30 Sept. 2009. Web. 7 Apr. 2010. <http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No3Sept09/Assessing-Health-Literacy-.aspx&gt;.

Goldberg, Debbie. “Artificial Heart Implant Leads to Suit Over Consent Process.” Washington Post[Washington DC] 30 Nov. 2002: A03. Washington Post. Web. 7 Apr. 2010. <http://www.washingtonpost.com/ac2/wp-dyn/A54921-2002Nov29&gt;.

Landro, Laura. “Consent Forms That Patients Can Understand.” Wall Street Journal. 6 Feb. 2008. Web. 7 Apr. 2010. <http://online.wsj.com/article/SB120224055435844931.html&gt;.

Pape, Tess. “Legal and Ethical Considerations of Informed Consent – Medical Consent.” AORN Journal 65.6 (1997): 1122-127. The Association of PeriOperative Registered Nurses. Web. 7 Apr. 2010. <http://www.aornjournal.org/&gt;.

Vollmann, Jochen, and Rolf Winau. “Informed Consent in Human Experimentation before the Nuremberg Code.” British Medical Journal 313.7070 (1996): 1445-1447. British Medical Journal. Web. 7 Apr. 2010. <http://www.bmj.com/cgi/content/full/313/7070/1445&gt;.

Yale-New Haven Hospital. “Risk Management Handbook.” Yale University School of Medicine, 1997. Web. 7 Apr. 2010. <http://www.med.yale.edu/caim/risk/handbook/rmh_informed_consent.html&gt;.

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3 responses

18 05 2010
MageRapsRab

Like the article!

20 05 2010
protogere

I appreciate your sentiments!

22 05 2010
Nothheili

It aint a proud part of our worlds history but that we learned so much about how hummans work from the nazis has saved lives. Not much different than davinci making cadavers out of prostitutes and drunks.

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