Rethinking Valid Informed Consent: Requiring Disclosure of Controversies and Standard of Care

Abstract

Purpose: This paper offers a normative argument for amending current informed consent standards to mandate disclosure of the standard of care and to require explanation of any controversial aspects of a recommended intervention. Discussion: Healthcare providers have a common law duty to inform patients of the benefits and drawbacks of the medical interventions they recommend as well as their alternatives. However, the materiality of informed consent, the actual substantive content of the discussions, though regulated by State law, is largely left up to individual providers’ judgments and expertise. This paper argues that whenever an intervention is controversial, patients have the right to understand opposing views. Explaining the disagreement between experts in the field conveys uncertainties about the interventions’ outcomes and supporting data. Conversely, explaining when an intervention is standard of care conveys experts’ confidence in the intervention and its outcomes. Discussing controversies and the standard of care helps patients hold more realistic expectations and furthers patient autonomy, trust, and beneficence. Moreover, by forthrightly sharing this information health care providers more accurately convey the state of the field as opposed to an individual provider’s beliefs. Conclusion: Discussing controversies and the standard of care during informed consent discussion furthers the goals of informed consent and should be adapted in clinical practice.