Informed Consent and Disclosure of Surgeon Experience
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.
KeywordsEthics Informed consent Autonomy Surgical decision-making Disclosure
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.
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.
Relies on what other local practitioners deem appropriate for disclosure.
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.
Allows state interference to protect a child’s interests over parental rights to refuse care.
Surrogate decision-maker who was previously designated by the patient when they were competent. Takes priority in the hierarchy of possible decision-makers.
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.
A process of disclosure of risks, benefits, and alternatives of treatment decisions.
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.
Situation where minors may have common-law rights to refuse medical treatment.
Attitude and practice where a physician decides what is best for the patient; may compete with autonomous decision-making by the patient.
Disclosure of what a reasonable patient would want to know under given circumstances.
Requires the patient to use their own words to tell you what they understand about the procedure; assesses patient comprehension during informed consent.
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.
Rely on risks disclosed that are pertinent to an actual patient’s decision to accept therapy.
Has authority to act on behalf of a patient’s previously described wishes and values when a patient lacks decision-making capacity.
Process of acting on behalf of a patient’s previously described wishes and values.
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