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Informed Consent

  • Sarah A. Markham
  • Dominick GadaletaEmail author
Chapter

Abstract

Informed consent is a complex process that has evolved over time, both in medical and legal practice. Rooted in the same ethical tenets as medicine, informed consent exists to protect both patients and physicians. It has evolved over time from a “reasonable physician” standard to a “reasonable patient” standard, reflecting the change in medicine from paternalism to patient autonomy. The current trend is toward “shared decision-making,” which involves an open discussion between the patient and his/her surgeon about the patient’s diagnosis, the natural history of the disease without treatment, various treatment options with their risks and benefits, and the expected outcomes. In this model, the surgeon and patient collaborate to select the intervention which best aligns with the patient’s goals and values. This is especially vital in the field of bariatric surgery, where the long-term outcome is predominately patient-driven. Patients pursuing weight loss surgery for an “easy fix” to obesity will be severely disappointed after surgery and may not recognize complications if they have not had comprehensive discussions with their surgeons. Research has shown that many patients continue to lack a clear understanding after informed consent, which can be improved by multimedia consent processes and repeat-back.

Keywords

Reasonable physician standard Reasonable patient standard Shared decision-making 

References

  1. 1.
    King JS, Moulton BW. Rethinking informed consent: the case for shared medical decision-making. Am J Law Med. 2006;32:429–501.CrossRefGoogle Scholar
  2. 2.
    Raper SE, Sarwer DB. Informed consent issues in the conduct of bariatric surgery. Surg Obes Relat Dis. 2008;4:60–8.  https://doi.org/10.1016/j.soard.2007.09.002.CrossRefPubMedGoogle Scholar
  3. 3.
    Mulsow JJW, Feeley TM, Tierney S. Beyond consent—improving understanding in surgical patients. Am J Surg. 2012;203:112–20.  https://doi.org/10.1016/j.amjsurg.2010.12.010.CrossRefPubMedGoogle Scholar
  4. 4.
    Jones JW, McCullough LB, Richman BW. A comprehensive primer of surgical informed consent. Surg Clin N Am. 2007;87:903–18.  https://doi.org/10.1016/j.suc.2007.07.012.CrossRefPubMedGoogle Scholar
  5. 5.
    Some Important Court Cases [Internet]. [cited 2017 Nov 5]. Available from: https://web.stanford.edu/~mvr2j/sfsufall/extra/courtcases.pdf.
  6. 6.
    Abaunza H, Romero K. Elements for adequate informed consent in the surgical context. World J Surg. 2014;38:1594–604.  https://doi.org/10.1007/s00268-014-2588-x.CrossRefPubMedGoogle Scholar
  7. 7.
    Spatz ES, Krumholz HM, Moulton BW. The new era of informed consent. Getting to a reasonable-patient standard through shared decision making. JAMA. 2016;315(19):2063–4.CrossRefGoogle Scholar
  8. 8.
    Falagas ME, Korbila IP, Giannopoulou KR, Kondilis BK, Peppas G. Informed consent: how much and what do patients understand? Am J Surg. 2009;198:420–35.  https://doi.org/10.1016/j.amjsurg.2009.02.010.CrossRefPubMedGoogle Scholar
  9. 9.
    Fink AS, Prochazka AV, Henderson WG, Bartenfeld D, Nyirenda C, Webb A, Berger DH, Itani K, Whitehill T, Edwards J, Wilson M, Karsonovich C, Parmelee P. Predictors of comprehension during surgical informed consent. J Am Coll Surg. 2010;210:919–26.  https://doi.org/10.1016/j.jamcollsurg.2010.02.049.CrossRefPubMedGoogle Scholar
  10. 10.
    Wee CC, Pratt JS, Fanelli R, Samour PQ, Trainor LS, Passche-Orlow MK. Best practice updates for informed consent and patient education in weight loss surgery. Obesity. 2009;17:885–8.  https://doi.org/10.1038/oby.2008.567.CrossRefPubMedGoogle Scholar
  11. 11.
    Madan AK, Tichansky DS, Taddeucci RJ. Postoperative laparoscopic bariatric surgery patients do not remember potential complications. Obes Surg. 2007;17:885–8.CrossRefGoogle Scholar
  12. 12.
    Eggers C, Obliers R, Koerfer A, Thomas W, Koehle K, Hoelscher AH, Bollschweiler E. A multimedia tool for the informed consent of patients prior to gastric banding. Obesity. 2007;15(11):2866–73.CrossRefGoogle Scholar
  13. 13.
    Kaufman AS, McNelis J, Slevin M, La Marca C. Bariatric surgery claims—a medico-legal perspective. Obes Surg. 2006;16:1555–8.CrossRefGoogle Scholar
  14. 14.
    ASMBS. Informed Consent [Internet]. 2017 June [cited 2017 Nov 5]. Available from: https://asmbs.org/resources/informed-consent.
  15. 15.
    Goldberger JJ, Kruse J, Kadish AH, Passman R, Bergner DW. Effect of informed consent format on patient anxiety, knowledge, and satisfaction. Am Heart J. 2011;162:780–5.  https://doi.org/10.1016/j.ahj.2011.07.006.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryNorth Shore University Hospital, Northwell HealthManhassetUSA
  2. 2.Department of SurgeryNorth Shore University Hospital and Zucker School of Medicine/Northwell HealthManhassetUSA

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