Substantial efforts have recently been made to reform the
physician-patient relationship, particularly toward replacing the
`silent world of doctor and patient' with informed patient
participation in medical decision-making. This 'new ethos of patient
autonomy' has especially insisted on the routine provision of informed
consent for all medical interventions. Stronly supported by most
bioethicists and the law, as well as more popular writings and
expectations, it still seems clear that informed consent has, at best,
been received in a lukewarm fashion by most clinicians, many simply
rejecting what they commonly refer to as the `myth of informed
consent'.
The purpose of this book is to defuse this seemingly intractable
controversy by offering an efficient and effective operational model of
informed consent. This goal is pursued first by reviewing and
evaluating, in detail, the agendas, arguments, and supporting materials
of its proponents and detractors. A comprehensive review of empirical
studies of informed consent is provided, as well as a detailed
reflection on the common clinician experience with attempts at informed
consent and the exercise of autonomy by patients.
In the end, informed consent is recast as a management tool for pursuing
clinically and ethically important goods and values that any clinician
should see as meriting pursuit. Concurrently, the model incorporates a
flexible, anticipatory approach that recognizes that no static, generic
ritual can legitimately pursue the quite variable goods and values that
may be at stake with different patients in different situations.
Finally, efficiency of provision is addressed by not pursuing the
unattainable and ancillary. Throughout, the traditional principle of
beneficence is appealed to toward articulating an operational model of
informed consent as an intervention that is likely to change outcomes at
the bedside for the better.
