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Informed Consent and Disclosure of Surgeon Experience

Surgical Ethics: Principles and Practice
  • Sabha GanaiEmail author
Chapter

Abstract

This chapter reviews ethical issues and legal precedent relevant to informed consent for surgical procedures using a shared decision-making framework. The process of informed consent is examined in a systematic fashion, including reviewing ways to improve doctor-patient communication and important considerations for documentation of the consent process. Disclosure of surgical experience will also be explored, including the complexities of dealing with statistics from surgeon-specific reports. Ethical principles including respect for patient autonomy, beneficence, and distributive justice and duty to tell the truth will be explored as relevant to the doctrine of informed consent.

Keywords

Ethics Informed consent Autonomy Surgical decision-making Disclosure 

Notes

Glossary

Best-case/worst-case model

Tool to inform patients of estimates and ranges for outcomes of both a surgical intervention and an alternative in order to help them synthesize a plan in alignment with personal goals and values.

Best interest standard

Process of making healthcare decisions with an intention to minimize harm and maximize benefit to a patient when there is no available surrogate decision-maker to allow for substituted judgment.

Community practice or professional standard

Relies on what other local practitioners deem appropriate for disclosure.

Decision-making capacity

Requires the patient to be able to (1) communicate a choice, (2) understand the relevant information, (3) appreciate the medical consequences of the situation, and (4) reason about the treatment options.

Doctrine of parens patriae

Allows state interference to protect a child’s interests over parental rights to refuse care.

Durable power of attorney for healthcare decisions

Surrogate decision-maker who was previously designated by the patient when they were competent. Takes priority in the hierarchy of possible decision-makers.

Fiduciary duty

Highest standard of care, where a person holds a legal or ethical relationship of trust and responsibility to act on the behalf of another party.

Informed consent

A process of disclosure of risks, benefits, and alternatives of treatment decisions.

Material risk

Risk when a reasonable person, in what the physician knows or should know to be the patient’s position, would be likely to attach significance to the risk or cluster of risks in deciding whether or not to forego the proposed therapy.

Mature minor doctrine

Situation where minors may have common-law rights to refuse medical treatment.

Medical paternalism

Attitude and practice where a physician decides what is best for the patient; may compete with autonomous decision-making by the patient.

Reasonable person standard

Disclosure of what a reasonable patient would want to know under given circumstances.

Repeat-back method

Requires the patient to use their own words to tell you what they understand about the procedure; assesses patient comprehension during informed consent.

Shared decision-making

Framework of doctor-patient relationship requiring (1) the sharing of information between parties, (2) the clinician offering options and then describing their risks and benefits, and (3) the patient expressing his or her preferences and values.

Subjective standard

Rely on risks disclosed that are pertinent to an actual patient’s decision to accept therapy.

Surrogate decision-maker

Has authority to act on behalf of a patient’s previously described wishes and values when a patient lacks decision-making capacity.

Substituted judgment

Process of acting on behalf of a patient’s previously described wishes and values.

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Suggested Literature

  1. Appelbaum PS. Assessment of patients’ competence to consent to treatment. N Engl J Med. 2007;357:1834–40.CrossRefGoogle Scholar
  2.   A case vignette that provides strategies on how to assess decision-making capacity.Google Scholar
  3. Childers R, Lipsett PA, Pawlik TM. Informed consent and the surgeon. J Am Coll Surg. 2009;208:627–34.CrossRefGoogle Scholar
  4.   An overview of ethical requirements for provision of informed consent.Google Scholar
  5. Pellegrini CA. Trust: The Keystone of the Patient-Physician Relationship. J Am Coll Surgeons. 2017;224(2):95–101.CrossRefGoogle Scholar
  6.   A framework for communication between patients and physicians that that help establish a bond of trust.Google Scholar
  7. Taylor LJ, Nabozny MJ, Steffens NM, Tucholka JL, Brasel KJ, Johnson SK, Zelenski A, Rathouz PJ, Zhao Q, Kewekkeboum KL, Campbell TC, Schwarze ML. A framework to improve surgeon communication in high-stakes surgical decisions: Best Case/Worst Case. JAMA Surg. 2017;152(6):531–8.CrossRefGoogle Scholar
  8.   A framework to improve surgeon communication in high-stakes surgical decisions.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Southern Illinois University School of MedicineDepartment of SurgerySpringfieldUSA

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