Consent, Communication & Decision Making

Informed consent to medical treatment is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care.

Physicians should engage patients whose capacity is impaired in decisions involving their own care to the greatest extent possible, including when the patient has previously designated a surrogate to make decisions on his or her behalf.

Withholding pertinent medical information from patients in the belief that disclosure is medically contraindicated creates a conflict between the physician’s obligations to promote patient welfare and to respect patient autonomy. Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient’s knowledge or consent is ethically unacceptable.

A placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect on the condition being treated. In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient.

Physicians have an ethical obligation to be considerate of patient concerns and anxieties and ensure that patients receive test results within a reasonable time frame.

Patients are entitled to choose their own physicians. A surgeon who allows a substitute to conduct a medical procedure on his or her patient without the patient’s knowledge or consent risks compromising the trust-based relationship of patient and physician.

In giving or withholding permission for medical treatment for their children, parents/guardians are expected to safeguard their children’s physical health and well-being and to nurture their children’s developing personhood and autonomy; Physicians should evaluate minor patients to determine if they can understand the risks and benefits of proposed treatment; The more mature a minor patient is, the better able to understand what a decision will mean, and the more clearly the child can communicate preferences, the stronger the ethical obligation to seek minor patients’ assent to treatment.

Physicians have a responsibility to protect the confidentiality of minor patients, within certain limits. In some jurisdictions, the law permits unemancipated minors to request and receive confidential services relating to: contraception, pregnancy testing, prenatal care, delivery services and care to prevent, diagnose, or treat sexually transmitted disease, substance use disorders, or mental illness.

In many jurisdictions, unemancipated minors are not permitted to request or receive abortion services without their parents’ (or guardian’s) knowledge and consent. As such, when minors seek abortion care, this may create a conflict between the value of confidentiality and the legal obligation to obtain parental consent.

Decisions not to initiate care or to discontinue an intervention can be emotionally wrenching for the parents of a seriously ill newborn. Physicians should help parents, families, and fellow professionals understand that there is no ethical difference between withholding and withdrawing treatment, when an intervention no longer helps to achieve the goals of care or promote the quality of life.

Genetic testing of children implicates important concerns about the minor patient’s present and future autonomy and best interests. Decisions to test must balance multiple considerations, including: likely benefits, the risks of knowing genetic status, features unique to the condition(s) being tested for (such as age of onset), and the availability of effective preventive, therapeutic, or palliative interventions.

Electronic communication can raise special concerns about privacy and confidentiality, particularly when sensitive information is being conveyed. Physicians using electronic communication hold the same ethical responsibilities to patients as they do during other clinical encounters.

Social networks, and other forms of communication online create new challenges to the patient-physician relationship. Physicians and trainees have an ethical responsibility to weigh a number of considerations when maintaining a presence online: abiding by standards of patient privacy and confidentiality, maintaining appropriate professional boundaries and recognizing that actions online and content posted may negatively affect their reputations.

Informing a patient’s family that the patient has died, is a duty that is fundamental to the patient-physician relationship; In this process, physicians should give foremost attention to the family’s emotional needs and the integrity of the patient-physician relationship.

When physicians wish to express their personal political views to a patient or a patient’s family, the physician must be sensitive to the imbalance of power in the patient-physician relationship, as well as to the patient’s vulnerability and desire for privacy.

To sustain the trust that is the foundation of the patient-physician relationship and to reassure patients that their welfare is the physician’s primary priority, physicians who participate in fundraising should: refrain from directly soliciting contributions from their own patients, Protect patient privacy and confidentiality and be sensitive to the likelihood that they may be perceived to be acting in their professional role when participating in fundraising activities.

Surgical co-management refers to the practice of allotting specific responsibilities of patient care to designated clinicians. Such arrangements should be made only to ensure the highest quality of care.