Informed Consent

1. Front Matter

   Pages i-xiii

   PDF

2. Introduction

   1. Introduction

      • Stephen Wear

      Pages 1-4

3. The Sources of a Model of Informed Consent

   1. The Legal Doctrine of Informed Consent

      • Stephen Wear

      Pages 5-21

   2. The New Ethos of Patient Autonomy

      • Stephen Wear

      Pages 22-39

   3. The Clinical Experience of Patient Autonomy and Informed Consent

      • Stephen Wear

      Pages 40-54

   4. The Potential Benefits of Informed Consent

      • Stephen Wear

      Pages 55-66

4. A Model of Informed Consent

   1. Toward a Model of Informed Consent-Theoretical and Programmatic Considerations

      • Stephen Wear

      Pages 67-83

   2. The Informed Consent Event

      • Stephen Wear

      Pages 84-107

   3. The Issue of Competence

      • Stephen Wear

      Pages 108-133

   4. Exceptions to Informed Consent

      • Stephen Wear

      Pages 134-146

   5. The Enterprise of Informed Consent

      • Stephen Wear

      Pages 147-150

5. Back Matter

   Pages 151-169

   PDF

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'.
The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients.
In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better.

• Beauchamp
• Ethos
• autonomy
• beneficence
• diagnosis
• ethical theory
• health
• morality

`Stephen Wear, in this fine monograph, understands fully the problems with patient autonomy and informed consent. In fact he outlines with clarity the problems with complete informed consent ... In addition to Wear's informed consent process and the studies either supporting or not supporting its prevalence this book offers the reader a basic outline of medical ethics in regard to informed consent ... I recommend this book with great enthusiasm.'
The Journal of Medical Humanities, 16:2, 1995

• Department of Medicine, Department of Gynecology-Obstetrics, School of Medicine and Health Sciences, Department of Philosophy School of Social Sciences, State University of New York at Buffalo, USA

  Stephen Wear

• Ombudsman Consultation Team, Veterans Administration Medical Center, Buffalo, USA

  Stephen Wear

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