between assent and informed consent, stating that physicians violate their duty and expose themselves to liability by withholding necessary facts for an intelligent consent. Natanson v. Kline in 1960 delineated the scope of consent based on what a reasonable practitioner would disclose under similar circumstances. Canterbury v. Spence in 1972 emphasized the disclosure of all material information to the patient, irrespective of local practices, setting the “reasonable person” standard. Currently, most jurisdictions utilize either the “professional person” or “reasonable person” standard. While these legal cases established the precedent for requiring informed consent, the true requirement stems from a culturally-based respect for personal autonomy and an individual’s right to define their goals and make choices. Informed consent for medical treatment is widely accepted in the United States and many other countries. However, cultural norms influence the specific content of consent, including who receives the information and who participates in decision making. For example, the concept of ubuntu in South Africa prioritizes community over the individual, shaping their perspective on life and decision making. Similarly, Asian countries like Japan emphasize a “family- facilitated” approach, recognizing the importance of family involvement in patient decision making. These cultural differences contrast with the Western perspective, which emphasizes individualism and fundamental human rights, such as autonomy, privacy, and confidentiality. It is crucial to understand each patient’s perspective and tailor the process of obtaining informed consent accordingly, recognizing and respecting their unique cultural background and values. Minority Distrust in Medicine Understanding minority distrust in healthcare, its origins, and its impact on a patient’s ability to make informed healthcare decisions is crucial for obtaining informed consent. Unfortunately, this distrust has been well-founded due to historical instances of exploitation and mistreatment. For example, the Tuskegee Syphilis Study conducted in 1932 involved Black men who were infected
compared to White patients, even after controlling for relevant factors. Similarly, Black patients with chronic pain are less likely to receive opioid prescriptions compared to their White counterparts with similar pain severity. These instances of bias and unequal treatment have contributed to a deep-seated mistrust of the healthcare system among minority populations. These examples underscore the importance of informed consent, particularly for ethnic minorities and non-English speaking patient populations. Recognizing and addressing minority distrust, improving healthcare access and quality for underserved populations, and promoting culturally sensitive and inclusive care are essential steps in fostering trust, empowering patients, and ensuring that informed consent is obtained in a meaningful and equitable manner. Effective and Meaningful Informed Consent The goal of informed consent is to empower patients by ensuring they are fully informed and capable of making decisions about their healthcare while respecting their autonomy and individuality. Effective and valid informed consent comprises several essential components, including information disclosure, decision- making capacity, comprehension, cultural consideration, voluntariness, and documentation. Understanding each patient’s capacity and/or competency is crucial in the process of obtaining
informed consent. Various factors influence a patient’s capacity to give informed consent, such as age, disease severity, cognitive or mental disabilities, anxiety, level of education, and the healthcare provider’s communication skills. Additionally, language accessibility plays a vital role in patients’ ability to provide informed consent. Studies have highlighted the importance of language interpretation services. Among patients who did not receive required interpreting support, a significant percentage faced difficulties in comprehending medical instructions and harbored doubts about the reliability of the information received. Another study found that patients who received in-person interpretation services reported higher satisfaction levels and perceived that their concerns were better understood and more thoughtfully considered by their care teams compared to those who received interpretation services via phone. This demonstrates that language accessibility through appropriate interpreting services is crucial for facilitating effective informed consent. Demographic and cultural differences can also pose challenges to obtaining effective informed consent. Factors like age, gender, education level, and socioeconomic status can influence patients’ perception and understanding of medical information. For example, some adults may struggle with complex medical jargon, while individuals with lower levels of education may face difficulties with written materials. Considering these demographic factors is important when obtaining informed consent to ensure that patients have a clear understanding of the risks, benefits, and alternatives associated with their healthcare. Moreover, different cultures possess distinct beliefs, values, norms, and priorities that can impact how patients perceive medical information and make decisions about their healthcare. Healthcare providers should be cognizant of these cultural differences and adapt their communication and decision-making approaches accordingly to facilitate informed choices by patients.
A colleague offering discreet guidance on the optimal approach to a situation.
with syphilis without their informed consent and left untreated for forty years, leading to the deaths of several participants. Similarly, Puerto Rican women were unknowingly given oral contraceptives as part of a medical experiment without their knowledge or consent in the mid- 20th century. These cases are representative of the exploitation and mistreatment of minority populations in medicine. In addition to historical injustices, studies have consistently shown that minority populations face disparities in healthcare access and receive lower quality care compared to White Americans. Factors such as underinsurance or lack of insurance limit minority populations’ access to preventive care and necessary medical treatments. Geographical and language barriers further contribute to health inequities, with minority communities often having fewer healthcare providers and limited availability of language services. These barriers hinder effective communication, leading to miscommunication about medical conditions and treatments, ultimately impacting patients’ ability to make informed decisions about their healthcare. Discrimination and bias from healthcare providers also diminish the quality of care experienced by minority populations. Research has revealed disparities in pain management, showing that Black and Hispanic patients are less likely to receive adequate pain medication
Informed consent plays a key role in ensuring that patients have a comprehensive understanding of medical procedures and their potential consequences.
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PROMOTING HEALTH EQUITY THROUGH INFORMED CONSENT 77
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