Informed Consent

Informed Consent

Psychiatrists, like all other medical practitioners, face a dilemma: patients come to them for answers and treatment, and they ex-pect the psychiatrist to have those answers; however, treatment of mental illness is an uncertain process, and is not without risks. In order to give informed consent to treatment, patients must be given sufficient information concerning the risks and benefits of the proposed treatment; where outcomes are uncertain, they must also be informed of that uncertainty. The doctrine of informed consent has evolved considerably in the past several decades. The need to obtain a patient’s consent for treatment is grounded in the legal theory of battery, which is defined as an intentional touching of a person without that person’s consent. Provision of medical treatment is considered an intentional touching; if it is provided without the patient’s consent (and without other excep-tions, such as provision of emergency medical care), then it is a battery. Only after obtaining consent from a competent person may the physician treat the patient without risking liability for the tort of battery. As medical treatment has become more com-plex, and as concern for patients’ rights has grown, the notion of informed consent has evolved to require provision of ever more information to assist patients in making informed medical decisions.

Courts began setting modern standards for informed con-sent in the 1960s. The Kansas Supreme Court held that the quan-tum of information that a physician was required to provide was that which a “reasonable medical practitioner’’ would divulge (Natanson v. Kline, 1960). In 1972, the US Court of Appeals for the District of Columbia decided the landmark case of Canter-bury v. Spence, in which the court ruled that the physician had the duty to “advise patient of need for or desirability of any al-ternative treatment’’. Although the majority of states determine the sufficiency of disclosure by the standard of that which the reasonable practitioner would deem significant, some states take a more patient centered approach in which the quantum of in-formation is that which “would be regarded as significant by a reasonable person in the patient’s position’’ (Truman v. Thomas, 1980).

In general, then, the psychiatrist is obligated to disclose likely material risks of treatment, but not all possible risk, that is, the likelihood and severity of injurious side effects or death. Also, the psychiatrist should explain the need for treatment, and risks and the benefits of receiving or refusing the treatment. Finally, there should be a discussion of possible alternative treatments.

Obtaining informed consent for psychopharmacological treatment of children presents a particular challenge, since many psychoactive medications have not received FDA approval for use with children. Psychiatrists should be as clear as possible when explaining the state of knowledge regarding use of particular medications with children, so that the parent’s or guardian’s con-sent is as fully informed as possible.