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Informed Consent
Madison Krekow
California State University, Stanislaus


















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Informed Consent
Informed consent is an institution within the field of medicine that has become a source
of debate within recent years. According to Stoljar (2011), informed consent is the process of a
medical provider supplying relevant information to a patient in order for that patient to make an
autonomous decision regarding his or her medical care. There are a wide range of opinions
regarding informed consent by authors such as Gorovitz (1985) and Stoljar (2011). These articles
attempt to define the concept of informed consent and discuss whether or not the practice is
necessary and whether or not the efficacy of the current implementation of informed consent is
adequate to provide patients with true autonomy. Ultimately, informed consent, while performed
with good intentions, is not sufficient means to ensure the preservation of patient autonomy.
Informed Consent and Patient Autonomy by Samuel Gorovitz faces the issue of informed
consent and discusses it in terms of informing and consenting and how these two concepts affect
the process. Autonomy plays a large role in informed consent, and if a patient is not provided the
right to make decisions without coercion autonomy is violated therefore negating informed
consent (Gorovitz, 1985). Another key principle within the Gorovitz piece is the idea that
informed consent affirms respect for the patient, shows a physicians commitment to dignity, and
displays a commitment to rationality from both physician and patient. The argument that
Gorovitz (1985) then builds in regards to informed consent addresses these main principles
within five premises.
The first premise that he identifies is that patient and physician knowledge will always be
imperfect (Gorovitz, 1985). Within this premise, it can be understood that no matter how
educated or knowledgeable either physician or patient is about a particular medical procedure,
neither one will ever have a perfect understanding. Despite the imperfect level knowledge of
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physician and patient, informed consent will and should occur with highest level of knowledge
possible for both parties. The second premise within the Gorovitz (1985) piece is the idea that
treatment without permission is abuse. The trust that the public instills in doctors is immense and
the relationship that patients develop with their primary care providers becomes very intimate.
The procedures that doctors perform on patients in their regular practice would be considered
assault without the patient having previously agreed, making informed consent necessary. The
third premise that stated within the argument for informed consent is that although knowledge is
not perfect, it is not inadequate. The knowledge of doctors and patients will never be perfect but
informed consent must not be negated purely on that fact. Each patient also will have a different
educational level therefore the level of understanding that two different patients are capable of
may be vastly different. Informed consent must be achieved based on a realistic and achievable
level of understanding for each individual patient regarding the risks/benefits of a procedure
tailored to their cognitive abilities. The fourth premise for the argument on informed consent is
although information was not remembered, does not mean the decision was bad (1985). Amnesia
is a common side effect of the sedation used during surgery and often times patients will not
remember what happened hours before they received sedation. Although patients may not
remember the information given during the consent process after the procedure, they agreed to
the procedure before having been given cognitively impairing drugs and were in a coherent state.
Therefore, informed consent cannot be discounted purely based on the idea that patients cannot
remember the information after having received powerful sedative medications. The last premise
is that informed consent requires knowledge and understanding from both the physician and the
patient (Gorovitz, 1985).
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It is from these five premises that Gorovitz (1985) builds his conclusion that
informed consent is necessary, and physician knowledge is not superior to the autonomy of
patients. However, there have been arguments made regarding whether or not informed consent
truly ensures the autonomy of patients sufficiently. Within the article Informed Consent and
Relational Conceptions of Autonomy, Natalie Stoljar (2011) discusses informed consent in
regards to how well it fulfills the requirement of ensuring patient autonomy.
According to Stoljar (2011), informed consent is a medical institution that is practiced
under the context that it is both necessary and sufficient to maintain patient autonomy but has
failed to do so. Stoljar (2011) establishes that strong evaluation is required for autonomy as the
first premise of her argument. Being a strong evaluator means that a person must be capable of
ignoring societal norms and making decisions through a completely unbiased assessment of all
options. All patients, in the midst of crisis will have biases and emotions weighing down on their
decisions. The second premise of her argument is that informed consent requires only weak
evaluation. Most often during informed consent the patient is only presented with only one
option and is not made aware that other options are available which directly contributes to the
idea that only weak evaluation is necessary. The third premise of Stoljars (2011) article is the
idea that informed consent provides patients the opportunity to act, but does not ensure that
patients act on their own behalf. And the last premise established is that autonomy requires that
one take action on their own behalf (Stoljar, 2011). It is based on these premises that Stoljar
(2011) comes to the conclusion that informed consent is not sufficient enough to provide patient
autonomy.
As a nursing student, I have spent the last four years of my college career within the acute
care setting. I have had a vast experience within hospitals where informed consent in performed
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on a daily basis. Regarding the two opposing views on informed consent within the Gorovitz
(1985) and Stoljar (2011) pieces, I found myself agreeing with the stance that current practice of
informed consent is not adequate enough to create autonomous patients. There are three
mandatory components of informed consent that include: the material risks and benefits of a
proposed treatment, alternative treatments, and the consequences of no treatment (Kaibara,
2010). Within my clinical rotations I have never seen a physician provide information regarding
alternative treatments. This is in violation of the informed consent process.
According to Stoljar (2011) a person that is truly autonomous, regards [his or]
herself as the legitimate source of the authority, as able, and authorized, to speak for [his or]
herself (p. 376). Autonomy within this context as evaluated in a hospital setting therefore
requires that a patient be given all possible information that he or she can cognitively
comprehend regarding the disease process and treatment plans. Unfortunately, this is not the case
in most acute care hosptials due to large patient loads that both physicians and nurses suffer
from. It is on this basis that informed consent is not performed correctly on a regular basis
forgoing one of the three mandatory pieces of information, and that autonomy requires all
information be provided to a patient that I come to the conclusion that informed consent does
not ensure patient autonomy.
All human beings, within the acute care setting or not, have the right to be free and
autonomous individuals. Informed consent is an institutionalized practice that, with good
intentions, was created to ensure patients remain autonomous despite the vulnerability of disease.
Unfortunately, patient autonomy is not adequately protected by this process and often times
patients are given treatment that physicians think are best rather than making these decisions for
themselves. While I am not suggesting that informed consent be stopped within the hospital
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completely, I do believe that it should be improved upon for the safety and autonomy of people
who find themselves within the midst of the acute care setting,





















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References
Gorovitz, S. (1985). Informed consent and patient autonomy. From doctors dilemmas: moral
conflict and medical care (pp. 182-188). New York: Oxford University Press.
Kaibara, P. D. (2010). Eight ways to improve the informed consent process. The Journal of
Family Practice, 59(7), 373-376. Retrieved from http://web.ebscohost.com.ezproxy.
lib.csustan.edu
Stoljar, N. (2011). Informed consent and relational conceptions of autonomy. Journal of
Medicine and Philosophy, 36, 375-384. doi: 10.1093/jmp/jhr029