Informed Consent and Quality of Available Information
by: Christian Munthe
Presented at the 4th World Congress of the International Association of
Bioethics, Tokyo, November 4-7, 1998.
Abstract
Standard versions of the requirement of informed consent
state that patients who are offered to enter a clinical trial of a medical
procedure should be informed about risks and possible benefits of this
procedure (compared to available alternatives) in order to facilitate a
rational decision whether or not to participate. However, in many real
cases where new medical procedures are to be clinically tested for the
first time the information available for such communication to prospective
patients is very scarce, vague and/or uncertain. This phenomenon is illustrated
by the clinical introduction of new procedures in reproductive medicine,
such as preimplantation genetic diagnosis (PGD). Regarding such procedures,
it has ben argued that, in such cases, the quality of the available information
may be too low for the obtaining of informed consent to be possible, even
if it is successfully communicated. Others, instead, holds that informed
consent may always be obtained regardless of the quality of the available
information. Unfortunately, the standard litterature on informed consent
give no clue as to which of these interpretations is correct.
This issue is explored by connecting the concept of informed
consent to ethical ideas of respect for autonomy and ideas of rational
decision making. It is argued, first, that low quality of available information
regarding the risks and possible benefits of a medical procedure may indeed
make the obtaining of informed consent from patients to undergo this procedure
impossible even in theory. However, it is also argued that whether or not
this is the case must be relativized to the actual needs and deires of
individual patients. Thus, regarding one and the same procedure, informed
consent may be impossible to obtain from some patients due to the low quality
of the available information regarding this procedure, but still be possible
to obtain from other patients.
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