Often when hearing the term “informed consent”, one thinks of the long legal document signed proceeding any sort of medical procedure, often surgeries. The point of this document is to make certain that the patient understands the steps of the procedure, accepts any possible risks and outcomes, and gives permission to the team of doctors to perform the procedure. This act of giving permission seems commonplace, especially when it comes to matters of one’s own body, but eight years ago, this form did not exist, and the term “informed consent” did not exist.
(2) In 1957, a man by the name of Martin Salgo underwent a procedure called an aortography due to poor circulation in his legs, a condition known as arteriosclerosis. In this procedure, he was injected with radioactive dye followed by x-rays to see if there was a blockage in his aorta. When Salgo woke up, he had permanent paralysis, a potential complication that he had never heard of in regards to his procedure(3). His doctor had failed to inform him of the possible severe risks, and so Salgo had consented blindly to the procedure. Thus ensued the court case of Salgo v. Leland Stanford Jr. University Board of Trustees. With this key case in history, the term “informed consent” was created(4). Lawyer on the case, Paul G. Gebhard coined the term stating that Dr. Gerbode, Salgo’s surgeon, did not disclose all of the risks involved with the procedure and thus Salgo was not properly informed. (5) His consent to the procedure was made without having the complete information, and so Dr. Gerbode’s actions were not ethical. In addition, part of a doctor’s job is to disclose the necessary information to patients, which means that making certain that a patient’s consent is completely informed is a priority(6).
When dealing with informed consent, the most important thing to keep in mind is that all people have a right to be in control of their own body(7). Therefore, physicians need explicit consent in order to operate, perform a procedure, or do anything that will affect a person and his or her body. That being said, in order to do their job, physicians must first make sure that the patient understands exactly what the procedure entails going through each step carefully from beginning to end. This includes before the procedure, going over all possible outcomes and risks as well as the probability of success(8). The patient must understand what life could look like after the procedure, and if the risks are too great, they have the right to deny treatment. Doctors must go over any other procedure that could be a possibility instead of the one at hand as well, making sure that patients understands all of their options(9). A doctor's job is to cure and heal, but sometimes the risks can be great. Physician's are always trying to find a balance between risk and reward, and in some cases, the side affects can be great in order to achieve the desired result. While oftentimes their decisions are the most informed and the best option, doctors must keep in mind the wishes of the patient, allowing them the ultimate decision over their body and giving them to choice of the reward including the potential risks.
There are four main steps in obtaining informed consent: capacity, voluntariness, information, and consent(10). Capacity involves understanding, making sure that the patient is completely aware of all aspects of their illness and all potential treatment(11). Next is the patient's willingness or voluntariness of the patient to move forward with the procedure. With this step, it is important to keep in mind that the patient's willingness excludes all outside forces, so if the patient ever feels pressured into accepting treatment, this step has not been fully met(12). The patient must be fully and completely informed of what is wrong with them, why they need a procedure, what that is, (13) what other options they have, and what risks and benefits there are. They must be fully educated and allowed to think over the information(14). Finally, consent may be achieved and is necessary before moving forward(15). This often includes signing of a legal document, the consent form.
Despite the process of obtaining informed consent, it is not always fully achieved. Oftentimes, overwhelmed by the mandatory spiel from the doctor and the scary situation facing them, patients will blindly sign the consent forms without themselves fully comprehending their options. In a study done on cancer patients, only 18% asked questions which lead to a new and better course of treatment due to them being better informed(16). Sometimes it takes patients and cooperation to have the best aspects of informed consent fully realized.
1. Informed Consent. Photograph. Medical Claim Legal. 2. Informed Consent Form. Photograph. Natural Blaze. 3. Salgo v. Leland Stanford etc. Bd. Trustees, 17045 U.S. (California Court of Appeals). 4. Douglas S.T. Green, C. Ronald MacKenzie. "Nuances of Informed Consent: The Paradigm of Regional Anesthesia." HSS Journal, January 3, 2007. 5. El Palo Alto. Photograph. Stanford. 6. Salgo 7. Green and MacKenzie. "Nuances." 8. Ibid. 9. Ibid. 10. Ibid. 11. Ibid. 12. Ibid. 13. Signing Informed Consent. Photograph. Generation Progress. 14. Green and MacKenzie. "Nuances." 15. Ibid. 16. Barron H. Lerner. "Beyond Informed Consent: Did Cancer Patients Challenge Their Physicians in the Post-World War II Era?" Journal of the History of Medicine and Allied Sciences 59, no. 4 (October 2004): 514.