Informed Consent

Informed consent is a voluntary decision to go forward on a health-related matter. Consent may be an agreement to undergo a diagnostic test or a treatment. Consent becomes informed when the person has the ability to understand and ultimately does understand the potential benefits and risks of his decision and the alternatives to the choice he is making. When a person gives consent, the doctor and all other health care practitioners are then legally and ethically obligated to abide by the conditions of the consent agreement. Their obligation ends only if the person later withdraws or modifies consent.

Underpinning informed consent is a person's right to self-determination. Self-determination means, in the language of one judge, that "every human being of adult years and sound mind has the right to decide what shall be done with his own body." Doctors are legally and ethically obligated to respect a person's right of self-determination, or autonomy. However, self-determination and consent do not mean that a person can dictate health care services. The doctor is obligated to provide choices among medically appropriate options. The person cannot demand diagnostic tests or treatments that the doctor determines are unsafe or unnecessary.

The right of informed consent has a partner of sorts: the right of informed refusal. In other words, doctors have the same legal and ethical obligation to respect "no" as they do "yes." However, if a person declines a recommended diagnostic test or treatment, then doctors must continue the discussion to ensure that the person fully understands the choices at hand. Although doctors may encourage acceptance of a choice judged to be in a person's best interests, they cannot resort to coercion or deception.

Informed consent and informed refusal sometimes require time for full consideration. They arise from an appropriately thorough discussion between doctor and patient. The doctor is responsible for sharing information along with support and advice. The person making the decision is responsible for listening carefully and asking questions until the choices are understood.

Family members need to be aware that older people who cannot easily understand or evaluate alternatives may be treated as if they can, simply because they quietly go along with a plan proposed by a doctor. Also, older people may have vision or hearing loss or other disorders or may experience drug side effects that impair their ability to comprehend and communicate. They also may have family members who for whatever reason want to influence their decision making.