The myth of informed consent: in daily practice and in clinical trials
Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American sc...
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| Veröffentlicht in: | Journal of medical ethics 1989-03, Vol.15 (1), p.6-11 |
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| creator | Silverman, W A |
| description | Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests. |
| doi_str_mv | 10.1136/jme.15.1.6 |
| format | Article |
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Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests.</description><identifier>ISSN: 0306-6800</identifier><identifier>EISSN: 1473-4257</identifier><identifier>DOI: 10.1136/jme.15.1.6</identifier><identifier>PMID: 2926788</identifier><identifier>CODEN: JMETDR</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and Institute of Medical Ethics</publisher><subject>Beneficence ; Bioethics ; Clinical research ; Clinical trials ; Clinical Trials as Topic ; Controlled clinical trials ; Disclosure ; Experimentation ; Government Regulation ; Informed consent ; Informed Consent - legislation & jurisprudence ; Legal consent ; Medical practice ; Medical research ; Personal Autonomy ; Physician-Patient Relations ; Physicians ; Random Allocation ; Research Subjects ; Risk Assessment ; Truth Disclosure ; United States</subject><ispartof>Journal of medical ethics, 1989-03, Vol.15 (1), p.6-11</ispartof><rights>Copyright 1989 Journal of Medical Ethics</rights><rights>Copyright BMJ Publishing Group LTD Mar 1989</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b519t-71611aa661e1742f6eec1aad1c17e6e9c02e60de0a6062761c1b93ba44b6000b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/27716759$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/27716759$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,723,776,780,799,881,27848,27903,27904,53769,53771,57995,58228</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/2926788$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Silverman, W A</creatorcontrib><title>The myth of informed consent: in daily practice and in clinical trials</title><title>Journal of medical ethics</title><addtitle>J Med Ethics</addtitle><description>Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of medical ethics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Silverman, W A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The myth of informed consent: in daily practice and in clinical trials</atitle><jtitle>Journal of medical ethics</jtitle><addtitle>J Med Ethics</addtitle><date>1989-03-01</date><risdate>1989</risdate><volume>15</volume><issue>1</issue><spage>6</spage><epage>11</epage><pages>6-11</pages><issn>0306-6800</issn><eissn>1473-4257</eissn><coden>JMETDR</coden><abstract>Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and Institute of Medical Ethics</pub><pmid>2926788</pmid><doi>10.1136/jme.15.1.6</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of medical ethics, 1989-03, Vol.15 (1), p.6-11 |
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| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Periodicals Index Online; Jstor Complete Legacy; PubMed Central; Alma/SFX Local Collection |
| subjects | Beneficence Bioethics Clinical research Clinical trials Clinical Trials as Topic Controlled clinical trials Disclosure Experimentation Government Regulation Informed consent Informed Consent - legislation & jurisprudence Legal consent Medical practice Medical research Personal Autonomy Physician-Patient Relations Physicians Random Allocation Research Subjects Risk Assessment Truth Disclosure United States |
| title | The myth of informed consent: in daily practice and in clinical trials |
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