Informed Consent: Special Problems for Psychiatry

There is a growing demand for more patient autonomy in the doctor-patient relationship, and legal reformers believe that an expanded doctrine of informed consent is the key to change. Informed consent is meant to force the doctor to give the patient the knowledge that will make him an equal bargaining partner. However, most evidence demonstrates that the majority of patients do not comprehend or retain medical information. Further, the legal doctrine of informed consent has never been coherently worked out. Informed consent in psychiatry is particularly complicated, because of the constitutional implications of right-to-refuse-treatment litigation and because patients may be incompetent to give informed consent as a result of their illness. One of the special problems for psychiatry is that complex consent requirements have been mandated by those who oppose certain somatic therapies. The author discusses the implications of these legal developments. He lists the kinds of informed-consent and refusal-to-consent situations psychiatrists face and comments briefly on the most troublesome.