1-15. ELEMENTS OF DISCLOSURE
a. Providing the Information That Will Facilitate The Patient's Decision
Making. Professionals are obliged to disclose a core body of information. Without an
adequate transfer of information, many patients will have insufficient information for
decision-making. The health care professional's perspective, opinions, and
recommendations are often useful and relevant for the patient's consideration, as well
as for mutual understanding. Even if not always essential, the provider's input is
certainly useful and relevant.
b. What to Disclose. The purpose and nature of authorization as an act of
consent should be explained. The facts that patients usually consider relevant in
deciding whether to refuse or consent to intervention should be covered. And, any
information that the physician believes to be relevant, together with the clinician's own
recommendations, should be outlined. All explanations should be made in layman's
terms, so that they can be easily understood. The usual elements of an explanation are
summarized below.
(1) The purpose and nature of authorization as an act of consent. (Self-
explanatory; see paras 1-2 and 1-5.)
(2) The nature of the treatment. This is a statement of the patient's
condition or problem and an explanation of the nature and purpose of the proposed
treatment.
(3)
Possible and probable benefits of treatment. (Self-explanatory.)
(4) Probable risks and consequences (seriousness and frequency). A
reasonable disclosure of the dangers that are possible is required. This does not mean
that the physician is obliged to describe in detail all of the possible consequences of
treatment. In fact, full disclosure (an explanation of all facts, diagnoses, complications,
and alternatives) would be bad medical practice, as it would unduly alarm and confuse
the patient. Only risks that are known (or should be known) by the physician to occur
without negligence must be disclosed. Nearly all courts recognize that not all risks can
be disclosed. One useful guideline is to disclose the risks that have a large probability
of occurring and those with the most severe consequences. The seriousness of the risk
(for example, temporary paralysis) and the frequency of occurrences (for example, a 75
percent chance) should be discussed. Under the reasonable person standard (subjective
test), theunique informational needs of the patient should also be taken into account. A remote
risk that is not relevant to most patients might be crucial to some, depending on the
patient's beliefs, medical history, lifestyle, and so forth
(5) Feasible treatment alternatives and their likelihood of success.
Accepted alternatives that are reasonable should be discussed.
MD0067
1-32