By Dr. Vic Weatherall
A better understanding of the issue of "informed consent" and your rights can help you make wise health care choices and possibly avoid inappropriate care.
Before undergoing any health care procedure, you have the right to make an informed decision about what the care will involve. Consequently, your doctor (and all other health care providers) must obtain your "informed consent" prior to performing a procedure, writing a prescription, or guiding a course of therapy. The purpose of obtaining your informed consent to a health care intervention (test or therapy) is to empower you to make educated choices in an environment of trust and cooperation.
The Ontario Health Care Consent Act of 19961 is a good example of typical informed consent legislation. It states that your consent to treatment is "informed" if you have received information about the matters listed below and you received responses to any request for additional information. "Treatment" is defined broadly as anything done for a therapeutic, preventative, palliative, diagnostic, cosmetic, or any other health related purpose. The Act states that you must be told the
The Act states that consent to treatment may be express (given in writing or verbally) or implied (indicated by an action or behaviour, such as rolling up a shirt sleeve). However, the basic elements of disclosure remain the same.
There are several exclusions to the term "treatment," as defined in the Act, including taking a history, performing an assessment to determine the general nature of a problem, and communicating a diagnosis to a patient. Of special note, it also excludes a treatment that, in the circumstances, poses little or no risk of harm to a patient.
The College of Physicians and Surgeons of Ontario policy Consent to Medical Treatment2 states that, in non-emergency situations, the patient must be capable and the consent must be related to the treatment, informed, and given voluntarily. As well, it must not be obtained through misrepresentation or fraud.
The Code of Ethics of the Canadian Medical Association3 states that you should receive the information you need to make informed decisions about your medical care, and that your questions should be answered to the best of your doctor's ability. It also states that doctors should recommend only those diagnostic and therapeutic procedures they consider beneficial. As well, your doctor should respect your right as a competent patient to accept or reject any recommended medical care.
The issue of informed consent is a worldwide concern. Informed Consent for Medical Treatment4 written by Dr. Nili Tabak of the Society for Patient's Rights in Israel clarifies the purpose of the informed consent legislation enshrined in the Israeli Patient's Rights Act of 1996. He states that informed consent is needed to
He goes on to specify that the practitioner, not the patient, must take the initiative to provide the information because the patient usually does not know what to ask or may hesitate to request information.
The best to way to get the information you need to make informed decisions is to engage in full and open dialog with your health care providers. Use the following checklist to make sure that you have all of the information you need: