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Tuesday, August 18, 2015

Informed Madness

Informed Consent vs. Waiver of Liability There was a study a few years back (hospice and palliative care literature) where they followed up with patient post-procedure and assessed whether they truly understood the pre-procedure consent forms they had signed. Almost no one understood the forms. Rather, patients signed because they wanted help and they feared that if they did not sign, they would be denied care. Is this truly informed and engaged decision-making? I think the courts have established in other areas such as contract law that decision-making under duress is not of free will nor informed and, therefore, is not a binding contract. In my opinion, these pre-procedure forms are more about a waiver of liability rather than about informed decision-making. Patients definitely deserve the opportunity to engage in informed decision-making, but there are many ways to gain informed consent. As an example, there is informed community consent. For instance, would citizens of this community be surprised that if they present to an ER with crushing substernal chest pain, shortness of breath and with EKG and blood work evidence of a heart attack that certain steps to preserve health and wellbeing (aspirin, nitrates, betablockers, etc) are immediately and reflexively undertaken? If the answer is that most in the community would not be surprised by such reflex management, then perhaps the role of informed consent is to present an opportunity to opt out of usual care rather than to complete 10 pages to opt in to care they already expect. We have an opportunity to improve our bioethics in the realm of informed and engaged decision-making.
from Rajesh Harrykissoon, MD I know what I'm doing is perhaps the most harebrained idea to ever infiltrate clinical medicine. But, I'm a rank-and-file soldier working within a hospital tanker ship. I've been told to do it this way. And, so, I perpetuate the madness.