Abstract
Any attempt to characterize the dominant view of clinicians on patient autonomy and informed consent is precarious at best. On the one hand, the new ethos of patient autonomy is hardly just an outsider’s fabrication, fashioned by lawyers and philosophers. Indeed, some of its most forceful and well-known advocates have been physicians, e.g., Howard Brody, Eric Cassell, H. Tristram Engelhardt, Jr., Jay Katz and Edmund Pellegrino. On the other hand, the clinical literature is replete with heart-felt attacks on the “myth of informed consent” (Ravitch, 1978), a view often echoed on the firing line.
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Notes
That such a counseling and clarificatory response is appropriate in the case where a patient rejects recommended therapy is clear from many studies which indicate that it might well be due to such questionable factors as clinically treatable depression or significant misconceptions of his situation and prospects by the patient. See Jackson and Youngner, 1979, for the classic study of this problem.
If one were to simply average the results of past studies, the average would come out to around 50 percent recall of information provided. This is a very crude figure, however, as some studies focus on patient recall months after informed consent, as did Robinson and Merav, who found a 20 percent rate of recall (Robinson and Merav, 1976). Aside from falsely equating remembering after the fact with understanding at the point of consent, the significant effect of the normal forgetting process is well documented. Bengler, for example, found a 72 percent rate of recall at two hours past informed consent, and a 61 percent rate three months later (Bengler, 1980 ). Morgan and Schwab, for their part, tested immediately after consent and only received a 37 percent rate of recall (Morgan and Schwab, 1986). See especially Roth and Meisel’s “What We Do and Do Not Know About Informed Consent” for an extended discussion of the problems and flaws of the extant studies, as well as the reasons why no clear implications seem to emerge from them. (Roth and Meisel, 1981). Interpretation of studies beyond 1981 would also be usefully preceded by a review of this article.
For a fairly exhaustive list of most of the existing studies, see the bibliography of Meisel, 1983.
Cassileth, 1980, p. 896; Lidz, 1984, p. 318; see also Felines, 1970.
One could, of course, argue that the lack of careful reading of consent forms testifies to such a tendency in illness.
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© 1993 Springer Science+Business Media Dordrecht
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Wear, S. (1993). The Clinical Experience of Patient Autonomy and Informed Consent. In: Informed Consent. Clinical Medical Ethics, vol 4. Springer, Dordrecht. https://doi.org/10.1007/978-94-015-8122-6_4
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DOI: https://doi.org/10.1007/978-94-015-8122-6_4
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