As a Patient, Are You Giving Informed Consent?

As a Patient, Are You Giving Informed Consent?
Patients have the right to obtain all relevant information, both pros and cons. (George Rudy/Shutterstock)
Martha Rosenberg
11/21/2022
Updated:
11/21/2022
“Informed consent” in health care—in which patients are given risk and benefit information about a medical procedure or treatment beforehand—is supposed to be a cornerstone of doctor–patient interactions.

Yet in today’s environment of rushed medical visits and high volumes of patients for doctors to see, informed consent can be slighted. Patients can feel “not listened to” and hurried through without having their questions answered.

For example, 2022 research published in the journal Clinical Psychology & Psychotherapy found that as many as one in five psychotherapists admitted that they don’t inform clients about potential risks and side effects of psychotherapeutic modalities. Many said they failed to do so out of fear of provoking anxiety in their patients.
Research published in the journal Medicine, Health Care and Philosophy in 2022 notes that the role of informed consent “is often misunderstood.”

“Informed consent (IC) is a key patients’ right. It gives patients the opportunity to access relevant information/knowledge and to support their decision-making role in partnership with clinicians.”

Unfortunately, that often doesn’t happen.

Consent Comes First

According to Dr. Irene Campbell-Taylor, a Canadian doctor and clinical neuroscientist who spoke to The Epoch Times, patients don’t always realize that the American Medical Association’s code of ethics (Opinion 2.1.1) states that “informed consent to medical treatment is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care.”

“Actually, patients not only have the right to obtain all relevant information, both pro and con, but for a physician to prescribe and or operate without obtaining informed consent is medical battery,” Campbell-Taylor said.

“I have always found it amazing that people are quite content to have substances put into or taken out of the body without ever asking the most important, ‘Why and will it do any harm?’ The patient, not the physician, decides what will be done or ingested and the competent patient has the absolute right to refuse treatment even if it would mean death.

“Except in an emergency, a doctor, nurse, or therapist must obtain the patient’s consent before even touching him or her.”

When it comes to informed consent for research studies, consent from patients—who are called subjects—is much more complicated because of the higher risk of the protocols.

These consent agreements are governed by what are called “Institutional Review Boards,” usually affiliated with medical centers where the research will be conducted to ensure the safety and full knowledge of the participants.

Legal and ethical questions also swirl around cases in which a patient in an acute setting can’t give informed consent because of a physical or medical condition or dementia. Sometimes, in these cases, family is enlisted for decisions about informed consent of their relative or loved one.

Informed Consent About Medications

As pharmacology has advanced, medications have become more medically consequential and more expensive and patients remain on them for longer periods, often taking many medications at once—a practice called polypharmacy—for the final decades of their lives. This situation raises more questions about informed consent pertaining to medications themselves.

Unfortunately, patients and doctors are often reluctant or uninterested in asking these questions.

“The millions of resultant tragedies [from medication use] every year constitute a disgrace for the medical profession that increasingly forgets to obtain data on the side effects of all medications, inform the patient, and stop relying on the information provided only by the pharmaceutical company representatives,” Campbell-Taylor said.

“I regret to say that much of the damage inflicted by adverse side effects of medications is the shared responsibility of physicians and the patients themselves who avoid obtaining essential information and thereby being unable to make reasoned decisions.”

According to Campell-Taylor, before a physician even touches a patient, he or she needs permission. However, she noted that physician exams seem to be disappearing in favor of routine drug prescribing.

“It has been years since I have heard a patient tell me that they were actually examined [by a  physician] as opposed to merely talked to ... [leaving] with a prescription in hand,” she said.

“Few Americans realize that the United States ranks last in health care rankings compared with Australia, Canada, the Netherlands, Germany, Switzerland, France, New Zealand, Norway, Sweden, and the United Kingdom.”

Medical error is the third leading cause of death in the United States, according to a 2016 study conducted by researchers at John Hopkins Medicine.

The researchers said the Centers for Disease Control and Prevention’s method of collecting national health statistics fails to classify medical errors separately on death certificates and called for changes to how deaths are reported to better reflect reality.

While the Hopkins researchers said those errors include systemic problems, such as “poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols,” another researcher lays far more blame at the hands of pharmaceuticals.

“Our prescription drugs are the third leading cause of death after heart disease and cancer in the United States and Europe,” professor Peter Gotzsche wrote in a 2014 paper. Gotzsche is a specialist in internal medicine who co-founded The Cochrane Collaboration in 1993 and The Nordic Cochrane Centre in the same year.
With medical errors and drugs being such high-risk factors for death, it appears even more critical that patients be given the right to decide, with eyes wide open, as to whether they want to proceed with any given treatment.

What Can Patients Do?

Even if doctors don’t fully inform patients about medication risks, benefits, and side effects, prescriptions almost always come with printouts and patient education sheets which describe all the drug effects in detail. But it’s hard to know if patients read them and how well they understand them. According to James O'Donnell, an associate professor of pharmacology at Rush Medical College Chicago, there are important questions patients should ask their doctors:
  • Should I discontinue or modify the dose of any drugs that I’m taking?  (Make sure that the prescribing doctor knows all of the drugs prescribed by other doctors)
  • What should I expect the new drug to do?
  • How long does it take to make a difference, one that I will feel or you, in monitoring, can determine?
  • What are the common toxicities and side effects (fainting, trouble getting up or out of bed, rashes) and what can I do to mitigate problems associated with food or exposure to sunlight?
  • How frequently or soon do I need to be monitored by you in regard to the new drug? Do I need any lab work, blood, or urine tests?
O'Donnell recommends that the first prescription should be limited in the number of pills it contains in case the patient can’t tolerate the medications. He also advises patients to make use of the other drug expert at their disposal.

“Always request counseling by the pharmacist who fills the prescription,” he said.

O'Donnell also recommends that you fill all your prescriptions at a single pharmacy, and, if you have mail-order prescriptions, let each pharmacy know what you’re getting from other pharmacies.

“This provides the pharmacist with the information to conduct a drug interaction screen,” he said.

Finally, always tell the pharmacist and the doctor about any allergies you might have experienced, O'Donnell said. Give them the specifics of what your reactions were, such as itchiness, hives, or rashes.

“This information is very important. The same drug or any drug in the same class or a drug that cross-reacts should not be prescribed with a common allergy history,” he said.

Conclusion

Patients have the right to know all aspects of medical procedures and treatments that their doctors propose, as well as the right to accept or refuse physical examinations, said experts with whom The Epoch Times spoke. And, as medications become more bioactive in the human body, patients also have the right to request complete explanations from their doctors and pharmacists about the proposed drugs.
Martha Rosenberg is a nationally recognized reporter and author whose work has been cited by the Mayo Clinic Proceedings, Public Library of Science Biology, and National Geographic. Rosenberg’s FDA expose, "Born with a Junk Food Deficiency," established her as a prominent investigative journalist. She has lectured widely at universities throughout the United States and resides in Chicago.
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