The Limits of Informed Consent

It will come as no surprise to anyone who has read this far to know that we are enthusiastic supporters of informed consent. We believe that entitlement to adequate information and the right to make choices about one’s medical treatment are fundamental ethical rights that are every bit as important in the healthcare arena as, for example, free speech and due process of law are in the wider society. Moreover, informed consent does not merely have deontological value. We have argued that, if done correctly, informed consent can often lead to better doctor-patient relationships, better patient adherence to treatment plans, and a fuller understanding of the disease process on the part of the healthcare provider. Yet it is also important to understand the limits of informed consent so we do not try to make it do what it cannot do. For example, although informed consent may help in managing treatment, by itself it does not cure illness. The claims that have been made for informed consent, however, are sometimes almost that extravagant. Informed consent has been suggested as the means to protect patients from poor care (1-3), including involuntary care (4), and as a means to improve the outcomes of care (5,6). It has been proposed as the solution to the problems of nursing homes (7) and as a device for compensating patients who are harmed by poor medical treatment (8). None of these are entirely specious ideas. Several of them, indeed, may be correct in part, but it is important for us to understand what informed consent cannot do as well as what it can. Just as free speech does not guarantee good government and due process of law does not guarantee justice, so too informed consent cannot solve all of the problems of the healthcare system. In this chapter we explore some of the limitations of informed consent. Specifically, we want to suggest four propositions. First, informed consent is a mechanism for improving communication and decision making among healthcare providers and patients.