Uninformed Consent: An Offshoot of Illiteracy and Ignorance
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The doctor-patient relationship is based on an emotional bond of trust. In the yesteryears, the availability of treatment modalities and cures for a disease or deformity was relatively less. This had given the doctor very few options to exercise in professional practice. To compound the fact, the past patient populace was less aware of medical techniques and therapies. Thus it was the doctors’ sole decision to go ahead with a set of ‘tried therapies’ for evaluation and treatment of a disease process. With the advent of science and technology, modern medicine offers a wide variety of techniques to cure a given ailment. The well-informed patients’ role has become one of the most important aspects in choosing a particular line of treatment. The extended task of a modern doctor is to familiarize the patient to the disease, the likelihood of acquiring it, diagnostic tools, standard treatment, available alternative treatment methods and an overall knowledge of potential risks, side effects and consequences of the therapy. The patient shall be comforted and allowed to choose the most appropriate option. The doctor shall confer high respects and regards for the rights of the patient while delivering professional service so as to make the patient derive a maximum benefit out of the proposed medical plan.
The concept of ‘patient-autonomy’ may need to be given a face-lift, in the context of Indian medical practice, with special emphasis to the rural sectors of the society. Expecting an illiterate or semi-literate patient to make an ‘informed decision’ regarding the proposed treatment protocol would hardly be a reality. Hence, even in the twenty-first century health care, the doctors’ decision is considered as first and final. With the given circumstances, a doctor placed in such a situation may not find it worth or feasible to explain everything to the patient. The ethical doctrines of therapeutic privilege, complete or partial disclosure, comprehension, voluntariness and competence may find a very minimal application in such scenario. As the facts and figures convey, a vast majority of the rural Indian population is semi-literate or illiterate. It is estimated that India harbors one in every third illiterate person in the world (Times of India 2004). Expecting such people to understand the nature and quality of the methods of treatment, for which they are consenting, would be highly counterproductive and may create ‘mistrust’ between the patient and the health care provider.
A recent inclusion to such a dismal situation is an act done by a doctor on a patient, based on misrepresentation of the facts. A 16-year-old boy from a village near Ranchi, a sub-urban town of northern India was made to undergo surgical sterilization in a primary health centre, by a greedy neighbor and a paramedical faculty, who made the boy to consent for the procedure. False documents were created stating that the said boy was 28-year-old, a married man and a father of two children. The reimbursement money, which the Government awards to such beneficiaries in view of the family planning program encouraged by the Government, was received by the wrong doers, who gave a meager sum to the ill fated boy (Deccan Herald 2010). This case is an example of how the concept of informed consent can be easily tweaked in a illiterate person who is unable to comprehend options. To uphold the honor and dignity of the medical profession, physicians need to adopt a broader approach to obligations of information disclosure and informed consent before intervening with a patient’s condition. It is crucial upon the provider to adequately explain the options and to discuss with the appropriate representative when the patient himself/herself cannot understand the information. In order to change the paternalistic view of medicine, various sophisticated models have been developed like the “transparency model” (Brody 1999), the “shared-decision making model” (Elwyn et al. 2012), the “conversation model” (Katz 1984) and a “principles approach” (Beauchamp and Childress 1994). Taking a broader and transparent approach to treatment options by adhering to these models will definitely help alleviate ethical mishaps like the one described earlier. Equally important, this would also reduce misconceptions and false expectations on the patients’ side.
Further, it is distressing to note that such cases (Deccan Herald 2010) do prevail in spite of the Consumer Protection Act (CPA 1994) being in place which clearly states that the patient is a consumer of the medical establishment, and that they reserve the right to question the procedure they undergo, the pitfalls, side effects and the cost. Such cases would seldom attract publicity, as most of the victim patients are represented from the lower socio-educational groups, who choose to suffer in silence rather than voicing their concerns about the issue. Such incidents would instill disgust in the lay public about the general practice of medicine.
The need of the hour is to promote a trend of public dialogue and to achieve a transparency in medical practice in India, especially in sub-urban and rural regions of the country.
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