Should Informed Consent Include Disparities Data
Today’s post was inspired by a Denise Grady article I read in the New York Times Second Opinion column and the peer-reviewed article it summarized (see link below). Our main purpose at enBloom is to increase your literacy in health and medical issues and to empower you with tools to help you have productive conversations with your doctors and health care providers. Before you receive any major procedure in the hospital or even on an out-patient basis you are required to sign consent forms. These are legal documents that indicate you understand the procedure you are about to undergo and the regular risks of complications associated with that procedure. When teaching students health care ethics, I always impress upon them the fact that unless the patient truly understands the procedure and the risk, their job is not done. That is to say, you cannot have consent unless it is informed.
One of the reasons, we began to see the rise of centers of excellence in the last decades of the 20th century is because physicians recognized they could significantly decrease risk by increasing the volume of highly specialized procedures. Patients and health care consumers should also be aware of the fact that time and location of physician training has lead to variations in the way specific physicians treat specific conditions, a phenomenon referred to as practice patterns. This is one of the reasons why it is so important to seek a second opinion when you receive a serious diagnosis or you’ve been recommended to undergo serious treatment.
The peer-reviewed article, Should Informed Consent for Cancer Treatment Include a Discussion about Hospital Outcome Disparities from the Public Library of Science website discusses these very issues. It raises a controversial ethical question around which two groups of experts debate. Since a physician is obligated to do no harm to their patients as well as actively work to remove or reduce disease, pain, and suffering does it then follow that they are obligated to tell their patients if the best care available is indeed at another hospital or medical center? The discussion in the article was extremely provocative. Yet, it led me to another slightly related question. Now that we have documented evidence in the disparities of care among the various ethnic groups, do we take those into account when reporting risk for informed consent? If we currently do not, shouldn’t we do so if the consent is truly to be informed?
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