LEVELS OF INFORMED CONSENT
Physician transmits body of information.
Patient understands and consents to intervention.
Patient signs the proper form with an understanding of the major risks.
Two-way communication (dialogue).
Give-and-take between physician and patient.
Patient's unique circumstances and informational needs are identified.
Active involvement of the patient in Decision-making.
Patient and physician reach consensus.
Patient signs consent form.
Patient gives formal consent.
Figure 1-9. Levels of informed consent.
d. Meeting the Requirements of One or the Other Models of Consent.
It is possible to fulfill the requirements of informed consent in the larger decision-
making sense (the autonomy model), and yet not fulfill the more limited institutional
requirement for a legally valid authorization. A patient can autonomously authorize an
intervention, thereby giving an informed consent in the first sense. (He or she has
had a series of discussions with the physician on the pros and cons of alternative
treatment plans, thought about the options, and in a give-and-take has decided upon
a treatment plan with which both physician and patient are satisfied.) All the same,
the patient might not effectively authorize that intervention on the appropriate form,
thus not giving an informed consent in the second sense. An example of this is the
minor who cannot legally give consent, but who has participated in a decision-making
process on the course of treatment. What the courts require for informed consent is
that the physician has outlined the risks of a proposed intervention, the patient has
understood those risks, and the signature on a consent form has been obtained
e. Meeting the Requirements of Both Models of Consent. Hopefully,
informed consent, as it is practiced in the real world, will encompass both models of
consent: participation in decision making and a legally valid authorization based on
knowledge of the risks. The goal of informed consent is to enable patients to make
autonomous decisions about whether or not to authorize medical intervention.