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Ins and Outs of Informed Consent

Informed consent.  It sounds so elegant, so precise, so definitive.  Do you know what it means, exactly?

We have the right to help decide what medical care is best for us.  Now this sounds great, in theory, but what does it actually involve?  By law, health care providers must explain — using comprehensible layman’s language whenever possible  — what our health condition is when we seek care,  and what treatment options are available.  So informed consent means:

  • I have been informed.  I have received information about my health condition and treatment options.
  • I understand my health condition and those treatment options.
  • I am able to make a decision about what health care treatment I care to receive and I give my consent to actually receive that treatment.

Okay.  How does a health care provider obtain my (or your) informed consent?  First, they have to talk with me about the treatment.  They will then have me read over a description of that treatment, and sign a form.  Now we have written informed consent.

There are some instances, by the way, when nothing needs to be signed.  The health care provider may simply explain the treatment and ask me if I agree to the treatment.  That’s it.

What specific treatments need informed consent?

These medical procedures require written informed consent:

  • Most surgeries, even when they are not performed in a hospital.
  • Any other complex or advanced procedures or medical tests.  For example, a needle biopsy of the liver, or an endoscopy (during which a tube is placed down the throat to look at the inside of the stomach).
  • Radiation or chemotherapy to treat cancer.
  • Some blood tests, such as HIV testing (this varies by state).
  • Most vaccines.
What should happen during the informed consent process?

Here are the things that your doctor or other health care provider will need to explain when they ask us for our informed consent:

  • Our present health and reason for the treatment.
  • What will happen during the treatment.
  • The risks of the treatment and how likely these risks are to occur.
  • How likely the treatment is to work effectively.
  • Other options for treating the present problem.
  • Unknown risks or possible side effects that may crop up later on.
  • If the treatment is really needed right now, or if it can wait.

All of this should give us enough to go on to make a good decision about the proposed treatment.  You may find the health care provider asking you to repeat the information he or she just gave you back in your own words.  This is to be sure you understand that information.  If you are not comfortable and need more details about your treatment options, ask the health care provider where to look.  There are plenty of good websites and resources out there.  

What is our role in the informed consent process?

Although it may not always feel like it, we are important members of our own health care teams.  We need to ask questions and be sure we understand what is happening at each step along the way.  And we can refuse treatment; the doctors and others may not agree, but we cannot be forced to undergo treatment we do not want to have.   So stay involved in the informed consent process.

Other thoughts about informed consent

Obviously, informed consent is not needed in a real emergency, when any delay could compromise patient safety.  And some of us are no longer able to make an informed decision, say, someone with Alzheimer’s or in a coma.  In these cases, the health care team would try to obtain informed consent for any proposed treatment  from a surrogate decision-maker.  And even when you are not asked

for your written consent, you should still be told what treatments or tests are being done, and why.  This means:

  • Women should know the reasons for, and pros and cons of, a Pap test, mammogram and any other similar test.
  • Men should know the reason for, and pros and cons of, a PSA blood test for prostate cancer before the test proceeds.
  • Anyone being tested for an infection that occurs after sexual contact should be told details about the test and why they are being tested.
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