Reflections on Informed Consent: 40 Years After its Birth

Abstract

Dr. Jay Katz a physician and law professor at Yale University invites fellow physicians to set aside their dislike of informed consent and consider both its origins and possible future in the field of medicine. He notes that informed consent with its initial pronouncements on patient roles in medical decision- making surfaced in 1957 in US Supreme Court case entitled Salgo vs. Leland Stanford Jr. University Board of Trustees. The notion was expanded by Natanson vs. Kline in 1960 and by Cantenbury vs. Spence in 1972. Informed consent was not designed to serve as a medical blueprint for interactions between physicians and patients says Katz but rather to push physicians to articulate medical standards of disclosure that would better conform to basic legal principles. However the medical profession did not do this and the task of fashioning a doctrine responsive to both the realities of medical practice and the requirements of law remains to be done. Thus Katz advocates a reexamination of the unitary scope of the informed-consent doctrine in light of the diversity of medical practices. He argues that: disclosures may have to be limited to the most essential parts; that the fullest disclosures should be enforced and shared decision making should be an absolute requirement for acute disorders; that the pace of disclosure may have to be slower for conditions in which the prognosis is dire and a fatal outcome is likely; and informed consent could be dispensed with if the patient agrees for relatively minor time-limited disorders.