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what a patient says and how a patient behaves should be
noted. The surgeon must also secure a private discussion
with the patient, during which time the patient is made
aware of the informed consent process and his right to it.
22
If the patient does not wish to participate in the traditional
“Western” informed consent process, the surgeon should
make sure that the patient does wish the family to assume
the responsibility of decision-making. In this way, atten-
tion is paid to the patient’s wishes, even if autonomy in its
truest sense is being subjugated by other cultural values.
Finally, the surgeon must ensure that the family itself agrees
to make decisions on the patient’s behalf that are congruent
with the cultural beliefs of the patient—a difficult task
because members within a family may disagree with each
other over this issue.
22
In general, individual patient autonomy and the right to
fully participate in the informed consent process should be
upheld unless the patient explicitly indicates that family
members should be included or even be solely responsible
in the decision-making process. Although surgeons should
not believe that they need to protect patients from their
families, physicians should ensure that when a patient de-
fers to familial values or interests, the patient has done so
willingly. Continuously encouraging patients to be candid
about their familial values and interests can allow surgeons
to monitor the decision-making dynamic between patient
and family.
23
If a patient does seem dissatisfied or pressured
by the family dynamic, a private discussion with the patient
(and potentially the family) would be the first step in rede-
fining the best interests of the patient.
In conclusion, a strong doctor-patient relationship is a
critical component to the practice of good medicine. In
recent decades, the ethical and legal response to the histor-
ically paternalistic doctor-patient relationship that domi-
nated the field of medicine for centuries has evolved into
the current concept of informed consent. Informed con-
sent is best conceptualized as an ongoing process that in-
volves both information disclosure and authorization for
the procedure in question. The best approach to informed
consent combines elements of the subjective and reason-
able standards. Specifically, surgeons should learn as much
as is reasonably possible about a patient’s values and inter-
ests to provide treatment options and goals of care that
align with that individual’s interests and values. The sur-
geon should strive to disclose information, ensure patient
understanding, and facilitate and empower patients to be
active participants as decision-makers. When carried out
properly, informed consent not only serves to respect pa-
tient autonomy but perhaps more importantly, cultivates
and solidifies the patient-physician relationship.
REFERENCES
1.
Schloendorff v. Society of New York Hospital. 211 NY 125
(1914).
2.
Canterbury v. Spence. 464 F2d (1972).
Figure 2.
Navigating cultural and familial issues during the informed consent encounter.
Informed
Consent
and
the
Surgeon
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Childers et al
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