Opinion : Informed Consent and Error disclosure

Submitted as a position paper for my Med. and Society ethics class:

To respect a patient's rights as discussed previously, informed consent must be received from a patient or the patient's family. While few would argue that consent is a bad idea, the extent to which that consent is informed can be more controversial. In a patient-physician relationship, there is an inherent imbalance of knowledge that clearly favors the physician. The patient will never be able to close the knowledge gap completely, yet the extent to which they are informed of their situation, (the treatment options and possible outcomes) dictates the extent to which they can make the best choice. Problems can arise when patients are unable to grasp the facts of the situation or are unable to make a reasoned or logical choice. More importantly for physicians however, is when problems arise because they have not communicated all the facts, especially when these omissions are important to or may sway the patients choice. Along with the case of non-disclosure of medical errors, this leads to a state of ignorance on the patient's behalf, which can have negative ramifications in both treatment outcomes and especially in legal liability.

It is assumed that in all cases that the physician's goal is to minimize the patient's ignorance and his personal liability. Therefore, I propose a guideline that I will call the George W. Bush disclosure rules, in honor of the president's foreign policy. The rules can be summed up as: 1) Take the moral high ground, 2) stay the course, and 3) damn the consequences (have faith that those consequences will be better than the alternative outcomes would have been).
For part one, we will depart with the President's actual practice and state that the moral high ground is always to tell the entire truth. There should be no manipulating, distorting, or omitting relevant facts. The patient should be told the diagnosis, all the treatment options, and all the outcomes without any interpretation unless that interpretation is specifically requested. The physician's role in this stage will be as an educator, and full disclosure will fulfill his duty to the patient and allow a truly informed consent to be made.

For the second part, the physician must stay the course as far as telling the full truth and complying with the patient's decision. Several mitigating factors may arise as discussed in the text, such as family's wishes, physician's prejudices, economic considerations, or public safety, yet the physician must not allow these influences to effect delivery of the truthful full disclosure. The physician will need courage to deliver the whole truth in some cases, and must accept the old platitude that "truth hurts". It must be held evident that none of these circumstances are more important that the patient's health and human rights. If the patient chooses a treatment that the physician feels is not in their best interest, than the patient's rights are the chief concern and the physician must still comply with the patient's wishes to the best of his abilities.

The most difficult part of the plan may be to accept any consequences and have faith that the right thing was done. Consequences from an error disclosure could damage reputations and consequences from letting the patient choose a non-optimal treatment could be premature death. Full disclosure is always the best policy considering the big picture however; as reputations are made by difficult choices and patient deaths are often inevitable. Second guessing decisions will cause stress and not fix the past, and therefore should be avoided as useless. If applied consistently, the George Bush disclosure rules should minimize physician legal liability and empower patients. These rules are easy to remember and almost universally applicable. They provide a clear and decisive guide through the often conflicting and controversial issue of informed consent and disclosure.