f. The Role of Disclosure in the Institutional Model of Informed Consent.
In the more limited interpretation of informed consent, consent is often seen as the
obligation to inform patients. The legal doctrine of informed consent has been
primarily a law of disclosure, based on a general obligation to exercise reasonable
care by giving information. In this sense, the health care professional has a body of
information that needs to be transmitted.
g. The More Limited Role of Disclosure in the Autonomous Decision-
Making Model of Informed Consent. As stated above, disclosure plays an important
role in the legal/institutional definition of informed consent. However, from the moral
point of view, informed consent has less to do with disclosure, and more to do with
autonomous choices of patients and subjects. In the institutional sense, the health
care professional is seen as having a body of information to transmit. This is a one-
sided, physician-centered activity. But when the broader definition of informed
consent is considered, there is an information exchange between physician and
patient that is decidedly two-way. There is a dialogue, an exchange of questions and
answers on both sides, when joint decision-making is taking place. In this context,
transmission of information is less important. The patient may already have all the
information. What's important is discovering what information is relevant and how to
apply it to the patient's unique circumstances. This is not to say that disclosure is
unimportant. It is a necessary foundation for any decision-making. Without an
adequate transfer of information, many patients and subjects will have insufficient
information for decision-making. The physician's opinions and recommendations are,
after all, an important component of the patient's decision-making process.