So, let’s get back to the topic of informed consent. Is it possible that sometimes a patient can be given too much information? That may seem counterintuitive, but having been on the receiving end of informed consent recently, I am at least wondering whether more is always better when it comes to hearing about potential adverse effects. The first problem is that it is difficult, if not impossible, to describe all of the potential complications a patient might encounter. Even if you could describe an exhaustive list of potential problems, some are extremely unlikely (happening at most a few times in thousands of procedures) and may never have occurred in the hands of this particular caregiver.
Must the doctor describe every possible adverse event regardless of how infrequent it might be? I would argue that a line has to be drawn somewhere, and while one might debate where that line should be drawn, only those events that have a reasonable likelihood of occurring require discussion. The challenge, of course, is to define what constitutes a reasonable likelihood. One person’s reasonable likelihood might be another’s rare event.
Second, if the list of potential complications gets quite long, even if the risks of individual complications are quite small, the cumulative impact on the patient may be overwhelming. Somewhere along the way, information can morph into anxiety, and the patient may shy away from a procedure that offers them clear benefits that far outweigh a long, but highly unlikely list of complications.
As I started thinking about this issue, it occurred to me that even within health care, the expectations about informed consent vary. I cannot recall, for example, ever having had informed consent administered for treatment by a dentist, although I suspect that oral surgery may require it. What about outside of health care? There are many other risky activities for which society does not require the provider to give information or receive consent. One of our riskiest daily activities is driving in a car, but we do not require car dealers or manufacturers to provide informed consent. We do not require gun sellers or makers to provide informed consent. Even exercising in a gym carries with it some risk of injury, but we do not expect informed consent to be administered by the gym owner.
I am not suggesting that we diminish the role of informed consent. It is an essential part of ethical health care, and I still believe that, generally, the more information that is given to the patient, the better. Still, I do think that the whole process could be better standardized and we could come up with clear guidelines about what level of risk needs to be discussed. In the meantime, be forewarned, reading further could be hazardous to your health.
