Objectives

Ater reading this chapter, HEC members should be able to:

1. Define informed consent and shared decision-making.

2. Distinguish between ethical and legal requirements for informed consent.

3. Apply the concept of shared decision-making to a variety of cases involvingautonomy, professional authority, and disclosure.

Case 1

A woman is admitted to a teaching hospital in active labor. After some hours in unproductivelabor, her physician decides that oxytocin is needed to aid the labor and delivery. The physiciantells the charge nurse that someone must “consent” the patient before the oxytocin is administered.The nurse approaches the patient with a consent form and a dose of oxytocin. Thepatient hesitates to sign, saying she does not wish to waive her right to sue the doctors andhospital in case something is done incorrectly and the baby or mother is harmed. The nursetells the patient that, if she does not sign the consent form, she cannot deliver her baby in thehospital.

Case 2

After a teenager suggests suicide may be his best option, his parents take him to amental healthhospital and, after an intake interview, the teen is admitted for in-patient treatment. The nextday, the parents are called and told their son has met the doctor and been diagnosed with bipolardisorder. The parents go to the hospital in the evening and, upon arrival, are presented witha consent form. The nurse says, “If you want your son treated, sign this.” The treatment plan onthe informed consent form consists of one word, “Prozac,” which is not labeled for use as a soletreatment for bipolar disorder. When the parents ask for an explanation of the treatment anddiagnosis, they are told that only the doctor can give a full explanation. When the parents askto speak to the doctor, they are told he is not available. Instead, the parents are directed to ameeting with a caseworker with no direct knowledge of the patient who describes the diagnosticcriteria for bipolar disorder. The information presented is somewhat arcane to parents fearing for their son’s well-being, but it is not incomprehensible. When the parents ask whichof the criteria their son meets, they cannot get an answer, of course, because the caseworkeris unfamiliar with his symptoms and history. After repeated requests for more information andrepeated denials, the parents withdraw their son from the facility against medical advice andare told they are risking their son’s life.