Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Uninformed Consent – Revisited

Informed consent is a legal term in which a patient is said to have given consent based upon a clear appreciation and understanding of the facts, implications and future consequences of the surgical procedure. In order to give informed consent, the patient must have the capacity for clear reasoning and be provided all relevant facts at the time s/he gives consent. There are obvious impairments to reasoning and judgment. For example, intoxication or mental retardation would severely impact the capacity to give informed consent.

However, in the case of injured individuals there are several other factors that must be considered, and most often they are not:

Is the patient in such severe pain that s/he does not, or cannot, adequately concentrate and fully appreciate what is being explained?
Is the terminology used and examples given within the capacity of the patient to understand based upon education and experiences?
Is the patient of subaverage intellectual functioning with specific deficits in attention and integration of new materials?
Very frequently, I see a patient just prior to (or just following) surgery who has almost no understanding of what is being proposed and possible consequences, despite explanations repeatedly provided. They merely passively agree.

Equally as frequently, the patient has pain and other symptoms following surgery for which they feel they were never fully prepared and do not have even cursory understanding as to why such symptoms would arise.

While we may never see the time when all surgical patients are evaluated and cleared psychologically, you must wonder if at least some malpractice suits arise because of psychological lack of preparedness of the patient.

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