Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
More on Informed Consent Robert B. Howard To cite this article: Robert B. Howard (1979) More on Informed Consent, Postgraduate Medicine, 65:1, 25-25, DOI: 10.1080/00325481.1979.11715016 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715016
Published online: 07 Jul 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 22 August 2017, At: 12:54
PHYSICIAN-AT·LARGE
Downloaded by [Australian Catholic University] at 12:54 22 August 2017
Robert B. Howard, MD
MORE ON INFORMED CONSENT In the November issue of POSTGRADUATE MEDI(page 24) I commented on a particularly silly application of the informed consent doctrine, the insistence that researchers obtain informed consent from severely inebriated persons before the anonymous collection of their urine. I found this disturbing, and I find the application of informed consent in clinical situations even more so. I do not advocate keeping patients in the dark about their condition. On the contrary, I believe that physicians must discuss with the patient in understandable language the diagnosis; the symptoms being experienced; the outlook, including any likely complications; and recommendations for treatment, including the rationale for a particular selection, likely side effects, and available options. CINE
VOL 65/NO 1/JANUARY 1979/POSTGRADUATE MEDICINE
However, I object to the emerging concept that we must anticipate every twist a disease might take and every remotely possible complication of therapy, discuss these with the patient, and then, in effect, expect a decision by the patient. Surgeons already are essentially in this position. I cannot believe that the well being or recuperative powers of a patient with cancer of the colon will be enhanced by a preoperative discussion of anesthetic hyperthermia, postoperative wound dehiscence, and pulmonary infarction, to mention just three of the myriad possible complications of major surgery. Modern medications are vastly more powerful and effective than those of a generation ago, and most of them can cause serious mischief. (Vitamin B12 may be an exception.) Is it good medical practice to discuss with an apprehensive, febrile, partially obtunded patient with pneumonia the possibility that the medication selected may produce an anaphylactoid reaction or may cause exfoliative dermatitis, urticaria, serum sickness, fever, hemolytic anemia, leukopenia, thrombocytopenia, neuropathy, and/or nephropathy? Must I explain all of these and present optional forms of therapy, each of which has its own list of possible side effects? I believe that such action on my part would be inappropriate and irresponsible. Yet, if I interpret correctly the recent court decisions and awards, my failure to discuss even the rarest potential adverse reaction may expose me to successful legal action if such a reaction occurs. I believe that truly informed consent is an impossible goal in many, indeed most, of our daily clinical experiences. I believe that with each patient we must use our best professional judgment to guide the discussion-the disease, the patient's immediate clinical condition and intellectual capacity, and the actual probability of adverse events connected with treatment all are pertinent. Obtaining informed consent that meets strict legal requirements will solve few health care problems and will seriously impede recovery in many cases.
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ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
More on Informed Consent Robert B. Howard To cite this article: Robert B. Howard (1979) More on Informed Consent, Postgraduate Medicine, 65:1, 25-25, DOI: 10.1080/00325481.1979.11715016 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715016
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 22 August 2017, At: 12:54
PHYSICIAN-AT·LARGE
Downloaded by [Australian Catholic University] at 12:54 22 August 2017
Robert B. Howard, MD
MORE ON INFORMED CONSENT In the November issue of POSTGRADUATE MEDI(page 24) I commented on a particularly silly application of the informed consent doctrine, the insistence that researchers obtain informed consent from severely inebriated persons before the anonymous collection of their urine. I found this disturbing, and I find the application of informed consent in clinical situations even more so. I do not advocate keeping patients in the dark about their condition. On the contrary, I believe that physicians must discuss with the patient in understandable language the diagnosis; the symptoms being experienced; the outlook, including any likely complications; and recommendations for treatment, including the rationale for a particular selection, likely side effects, and available options. CINE
VOL 65/NO 1/JANUARY 1979/POSTGRADUATE MEDICINE
However, I object to the emerging concept that we must anticipate every twist a disease might take and every remotely possible complication of therapy, discuss these with the patient, and then, in effect, expect a decision by the patient. Surgeons already are essentially in this position. I cannot believe that the well being or recuperative powers of a patient with cancer of the colon will be enhanced by a preoperative discussion of anesthetic hyperthermia, postoperative wound dehiscence, and pulmonary infarction, to mention just three of the myriad possible complications of major surgery. Modern medications are vastly more powerful and effective than those of a generation ago, and most of them can cause serious mischief. (Vitamin B12 may be an exception.) Is it good medical practice to discuss with an apprehensive, febrile, partially obtunded patient with pneumonia the possibility that the medication selected may produce an anaphylactoid reaction or may cause exfoliative dermatitis, urticaria, serum sickness, fever, hemolytic anemia, leukopenia, thrombocytopenia, neuropathy, and/or nephropathy? Must I explain all of these and present optional forms of therapy, each of which has its own list of possible side effects? I believe that such action on my part would be inappropriate and irresponsible. Yet, if I interpret correctly the recent court decisions and awards, my failure to discuss even the rarest potential adverse reaction may expose me to successful legal action if such a reaction occurs. I believe that truly informed consent is an impossible goal in many, indeed most, of our daily clinical experiences. I believe that with each patient we must use our best professional judgment to guide the discussion-the disease, the patient's immediate clinical condition and intellectual capacity, and the actual probability of adverse events connected with treatment all are pertinent. Obtaining informed consent that meets strict legal requirements will solve few health care problems and will seriously impede recovery in many cases.
25
