How can informed consent be integrated into the physician-patient relationship in a manner that is respectful of both the idea of informed consent and the imperatives of clinical care? A realistic answer to that question could, we believe, remove much of the resistance of many healthcare professionals to the idea of informed consent. This chapter’s goal is to offer a practical procedural framework within which clinicians can operate to facilitate patients’ decision making in a manner that meets both these desiderata. The interactions of physicians and patients in making decisions about medical treatment can be conceptualized in two ways. Decision making can be approached as an event that occurs at a single point in time (an “event model”), or it can be viewed as a continuous element of the relationship between patients and their caregivers (a “process model”). The implications of these different ways of conceptualizing decisions about treatment are quite profound, rooted as they are in distinct visions of the relationship between physicians and patients. The event model of informed consent is predicated on a relatively simple paradigm. A patient seeking medical care approaches a physician for assistance. After assessing the patient’s condition, the physician reaches a diagnosis and formulates a recommended plan of treatment. The physician’s conclusions and recommendations are presented to the patient, along with information concerning the risks and potential benefits of the proposed treatment, and possible alternatives and their risks and potential benefits. Weighing the available data, the patient reflects on the relative risks and benefits of each course of action and then selects the medically acceptable alternative that most closely fits the patient’s particular values. On the surface at least, the event model conforms well to the legal requirements for informed consent. The event model emphasizes the provision of full and accurate information to patients at the time of decision making. Consent forms are often used for this purpose; indeed, the consent form can be said to be the central symbol of the event model (see Chapter 9). Patients’ understanding, although desirable in the abstract, is less crucial to this model than is the provision of information.
An analysis of systemic thinking in decision-making processes in the municipalities within the province of KwaZulu-Natal
