Informing Your Consent

Only with understanding can your consent be “informed.”

By Dave Hendry, Co-Founder, eSavvyHealth 

I’ve interacted with a fair number of doctors, both in relation to my own health and that of other members of my family, and it’s been my strong impression that every one of them had a sincere purpose to provide high quality care to their patients. Yet every time I walk into a doctor’s office I put on my critical thinking hat—the one that tells me never to assume that something is true just because someone in an authoritative position says it is (see eSavvyHealth Insight Thinking Critically About Health). So I suppose one might wonder, do I trust the health professionals that I consult with, or don’t I?

My answer is “partly.” I do trust that most of them will do the best they can for me within the frame of reference they are operating in. It’s the frame of reference that I have doubts about. 

Here are a few aspects of that frame that give me cause for concern: 

Doctors these days don’t have much time to spend with individual patients. They are expected to work on an assembly line basis, certainly giving each patient their full attention, but generally not for more than 15 minutes.

Pharmaceutical companies exert influence in all possible ways to get doctors to prescribe their products. Since they fund or sponsor much of the research that informs medical decisions, doctors (like the rest of us) are immersed in biased data.

In order to defend themselves against malpractice suits, doctors must be able to prove that they have advised patients based on published “standards of care” for treatments of various conditions. Those standards of care are supposedly research-based, so if the research is biased then so will be the standards. The consequence is that even if a doctor doesn’t believe the cited research, or considers it incomplete, they don’t have the freedom to deviate from standards of care guidelines without jeopardizing their careers. 

Doctors are human, and despite the best of intentions they make mistakes. That’s also true for nurses, and for health care institutions, all of which operate in or with a high-pressure, often stressful, environment that is not necessarily conducive to the degree of professional collaboration which can help prevent mistakes in any field. A 2016 John Hopkins study concluded that nearly 10% of U.S. deaths each year are due to medical errors, making such errors the third leading cause of death in the country. And those are just the errors which are serious enough to cause fatalities. We do not know about errors which may result only in gradual declines of health. 

None of this is reassuring, I know. As individuals trying to maintain our own health and that of those we care about or are responsible for, we have no power over any of these circumstances. But there is a factor that we DO have complete power over: our consent.

The fact that our consent must be given to any proposed treatment or intervention is both an ethical and legal obligation of health care providers. But that obligation goes beyond consent—the provider is further required to educate us about the “risks, benefits, and alternatives”1 of a given procedure or intervention. 

The principle of informed consent is a recognition of a very basic truth: as competent adults, in the final analysis we are each individually responsible for our own lives and health. Our responsibility doesn’t just lie in the act of our consent to a treatment, it also extends to making sure that we are, in fact, educated about risks, benefits, and alternatives. A health care provider can be sure that they have recited the standard language which their profession has determined covers all the bases, but only we can judge whether or not we’ve actually been educated. 

And with that we’ve landed squarely in the middle of my own profession. As an educator, I know very well that listening is not learning, and that the ability to recite information has a very faint relationship to the ability to understand it. The achievement of understanding requires much more than listening and recitation, and in particular it requires the decision to achieve understanding on the part of the learner.

Only with understanding can your consent ever really be “informed,” and understanding the risks, benefits and alternatives for a treatment has as a prerequisite an understanding of the operation of the human body. If you’ve made the decision to achieve that understanding, we are here to help.

References:

  1. Informed Consent, Shah P, Thornton I, Turrin D, et al. JUNE 2022. 

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