Informed consent: what does it mean?

Abstract

The editorial in the September 1982 issue of this journal and many articles before and since have addressed the problem of informed consent. Is it possible? Is it a useful concept? Is there anything new to be said about it? In this article the basic rationale of the rule (patient autonomy) is explained and the extent of the rule explored. Various exceptions have been offered by the law and an attempt is made to catalogue the chief of these. A number of specially vulnerable groups are then identified, the most important, and vexed, being children. How can informed consent be secured in the case of young patients? Finally, a few problems are mentioned in an attempt to get this subject back to reality. The appeal to the principle primum non nocere may be medical paternalism in disguise. Informed consent is the competing principle that reminds us of the primacy of human autonomy. A pointer is given to the future: even the use of sound recordings to explain medical procedures and to activate informed consent so that it may become a reality and not just a lawyer's myth, should be considered.

KIE: The chairman of Australia's Law Reform Commission discusses the concept of informed consent as an ethical priniciple grounded in respect for human autonomy and reflected in contemporary legal doctrine. In civil law, health care professionals have obligations to secure patient consent, although exceptions of varying merit to these obligations have been put forward. Problems continue to arise from attempts to define the meaning and scope of obligations to insure informed consent from all classes of patients and research subjects, particularly children. Kirby outlines suggestions for resolving the consent dilemma and re-emphasizes the principles of patient integrity and autonomy.