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Jul-Sep2003-11(3)
MEDICAL STUDENTS
SPEAK
Informed consent: consent with
a view
Neha Dangayach, Nikhil Joshi
Neha Dangayach, Nikhil Joshi
Aavishkaar, the annual intercollegiate festival of Seth GS Medical College and KEM Hospital, had a new event this year called OPIATE-Organised Platform for Interaction in Academic Themes and Events. The theme this year was 'Ethical issues in modern medicine'. This article summarises the dicussion on informed consent.
The root cause of most medical lawsuits is the
ill-understood nature of consent in medical practice. Informed consent is a
'process' of voluntary agreement, compliance or permission that is valid only if
it is given after understanding what it is given for, and the 'risks'
involved.
Since informed consent is a process, it must have a
definite beginning and an endpoint. To be legally valid, it must be 'informed'
and 'intelligent'. The law requires that the patient be fully informed of every
risk and relevant fact needed for giving a proper consent, and the consent
itself be based upon such material disclosure.
For the consent to be intelligent, it is necessary
that the patient understands what is explained. This would depend upon the
intelligence of the patient, something that is difficult to judge. If one lacks
clear guidelines, it is like being on an uncharted journey. There is no absolute
way because the information involved is subjective and individual-specific.
Thus, we start off on ambiguous grounds.
To make sure that the patient really understands
the information, one conveys it in the patient's own language, with the help of
an interpreter, if required. What if the interpreter misguides the doctor,
misinterprets the information unintentionally or out of vested
interest?
'How adequate is adequate?' A little more
information needs to be given to assess this. Thus, we add more information to
the information which may already ill understood. To ensure that the patient has
understood the material, he can be asked to explain the whole process. Thus, the
doctor can clear any ambiguities, resulting in a better doctor-patient
interaction.
'What happens if the doctor himself is not sure of
the step ahead?' He must let his patient know this for better transparency. This
will serve to cement the patient's faith in the doctor. Furthermore, it will
make the patient feel like 'a part of the treatment' rather than 'a subject of
the treatment'.
With regard to medical research, as the outcome of
the process is not fully known, the very basis of the word 'informed' is lost
and it is effectively a blanket consent. There is already staunch opposition to
the concept of a blanket consent.
Another issue involved is that of motivated
interests. While conducting a drug trial, the doctor has an interest in the
trial results. This might make him compromise the patients' interests. In
addition, consider the emotional state of the patient. Is it rational on the
part of the doctor to expect the patient (who is under physical and mental
trauma) to understand what it is that he is giving his consent for? Patients
tend to have more faith in the discretion of their doctors because they believe
that the doctor can make the best decision for them as he is emotionally
unbiased and more knowledgeable. Who will take the responsibility in the case of
any medical mishap?
We conclude that 'consent' should not be common for
all patients and needs to be individualised for every case. This is a
difficult task. The sheer analysis that such an elaborate process demands would
take a lot of time. It is impractical to expect a doctor to delve into such
matters when even basic patient care is being compromised by time.
Informed consent needs a fresh approach. We require
the process to undergo the ultimate test of its credibility-does it work in
practice to satisfy all or most of the shortcomings? With patient education at
an all-time high and better access to information on their health and disease,
doctors need to brace up with information that will enable them to tackle their
patients' queries in entirety before consent is given and taken. For doctors
working in a tertiary set-up, the challenges will continue to remain crude but
nevertheless changes for the better are needed now more than before, as much as
for the future.
NEHA DANGAYACH, NIKHIL JOSHI, Second year MBBS
students, Seth GS Medical College, Acharya Donde Marg, Parel, Mumbai 400012,
India. e-mail:dangayachneha@yahoo.com