Informed consent: the physicians' perspective

Using the current controversy in breast cancer treatment as a model, this paper reports on physicians' attitudes and behavior in the use of informed consent. Findings are based on a survey of 170 oncologists from eight countries and representing three medical specialties. Physician responses indicate that they regarded informed consent as an intrusion into the doctor-patient relationship. Problems identified by the physicians included: decreasingly effective doctor-patient communication; less personalized relationships with patients and curtailed freedom with regard to disclosure procedures. They also viewed the informed consent regulation as having a negative impact on their patient care. The constraints of obtaining informed consent reduced physicians' willingness to participate in scientific experiments. The consent form was seen to highlight their dual role as care-giver and scientific investigator, making them uncomfortable in dealing with patients. These findings demonstrate the ways in which legal restrictions associated with the introduction of new technologies critically affect the practice of medicine.     

Physician consent and researchers' access to patients

Institutional review boards may require that researchers obtain permission from a patient's physician before initiating patient contact. We describe how this requirement affected a study of head injuries. Physicians denied study participation to 8% of 243 subjects; 9% of 126 physicians denied contact with at least one subject. Most physicians responded within ten days, although seven required more than a month to respond. Delays in reaching potential subjects compromise some clinical research protocols. Physicians may refuse permission for some patients, introducing selection biases. Our study did not detect such an effect, but investigators should be alert to such problems in their own research.     

Informed consent: a pragmatic view

The author highlights some pragmatic aspects of informed consent that could help to bridge the gap between the currently valid legal requirements and the practical realities of providing medical information in Hungarian health-care settings. One of the crucial point of informed consent is whether the patient properly understood the provided medical information. Consequently, effective communication becomes an inevitable condition of providing informed consent. The results and insights coming from psychological research--concerning lay understanding of medical information, of the readability of consent forms, and especially of the lay understanding of statistical information, and risk communication--could help to create a better practice of medical communication that could satisfy both ethical and legal requirements. The author argues as well for creating more concrete and practically oriented guidelines concerning informed consent that would also help to increase the quality of medical information giving. These might help us approach the medical ideal that was conceptualised in the doctrine of informed consent.     

Informed consent: a pragmatic view

The author highlights some pragmatic aspects of informed consent, express consent and implied consent--by the cases of the Data Protection Commissioner of Hungary - that could help to bridge the gap between the currently valid legal requirements and the practical realities of providing medical information in Hungarian health-care settings. One of the crucial point of informed consent is whether the patient properly understood the provided medical information. Consequently, effective communication becomes an inevitable condition of providing informed consent. The author argues as well for creating more concrete and practically oriented guidelines concerning informed consent that would also help to increase the quality of medical information giving. These might help us approach the medical ideal that was conceptualised in the doctrine of informed consent.