Informed Consent

Abstract

Informed consent is a complex process that has evolved over time, both in medical and legal practice. Rooted in the same ethical tenets as medicine, informed consent exists to protect both patients and physicians. It has evolved over time from a “reasonable physician” standard to a “reasonable patient” standard, reflecting the change in medicine from paternalism to patient autonomy. The current trend is toward “shared decision-making,” which involves an open discussion between the patient and his/her surgeon about the patient’s diagnosis, the natural history of the disease without treatment, various treatment options with their risks and benefits, and the expected outcomes. In this model, the surgeon and patient collaborate to select the intervention which best aligns with the patient’s goals and values. This is especially vital in the field of bariatric surgery, where the long-term outcome is predominately patient-driven. Patients pursuing weight loss surgery for an “easy fix” to obesity will be severely disappointed after surgery and may not recognize complications if they have not had comprehensive discussions with their surgeons. Research has shown that many patients continue to lack a clear understanding after informed consent, which can be improved by multimedia consent processes and repeat-back.