Informed Consent and Disclosure

Katz introduces in his book, The Silent World of Doctor and Patient the origins of informed consent. "The birth date of informed consent was 22 October 1957" (Katz, 1984, p. 60). In those origins he shares that although informed consent and disclosure were introduced as standard, people have always had problems communicating with each other and therefore it leads to a disconnect when disclosure and consent are applied to medical procedure. Simply put, for the longest time, the physician-patient relationship has always included a certain level of silence. This was meant to keep patients from being too alarmed to go on with the treatment or procedure and to avoid any unsavory discussions. But when cases like Salgo v. Leland Stanford Jr. showed the court and the public the perils of not including informed consent, things began to change, albeit slowly, which only confirms that informed consent and disclosure were never a part of medical thinking and practice.

What was deemed a part of medical thinking and practice was faith in the physician's ability to do his or her job. Katz discusses this in his book and shows that while patients welcomed the inclusion of informed consent and disclosure, they felt they were being lied to because of the continued silence that has always existed in this kind of relationship. Katz suggests that patients justly so, feel cheated by "the duplicities, evasions, and lies that have infiltrated conversations with patients and made meaningful disclosure and consent a charade" (Caplan, 1987, p. 45). Implying the "ritual" of disclosure is more so a formality than an actual act of compliance and patients can discern the genuine attempts from the ingenuous ones. Going back to the trust established in the physician-patient relationship, blind faith, based on empirical evidence, does not suggest it aids against the struggle of disease. In fact, obedience and compliance are not gained through blind faith, but rather being informed. "Obedience, compliance, and trust are, in the appropriate settings, virtues not vices" (Caplan, 1987, p. 46).

Obedience and compliance are facilitated through being informed and recognizing another's limits and fallibility instead of obedience to authority and blind trust. Whether informed consent and disclosure is a part of this feeling of being informed has all to do with how much the physician is willing to communicate to the patient. Again it leads to an issue of communication and the degree of silence. This is something that has long existed in medical field.

Which leads to my agreeance of Katz's claim that both informed consent and disclosure were never truly part of medical practice and thinking. Going back centuries, and even now in the present, many people simply let doctors perform tests without asking questions because they expect the physician to know how to help them. Only when the patient takes it upon his or herself to ask questions and ask to be informed, does it change, not so much so with the introduction of informed consent and disclosure. Merely, the physician half-heartedly sticks to the standard, instead of actually communicating with the patient.

B.

Katz explains later on in his book the lack of evidence showing committed implementation. The "legal vision" of informed consent, is just an illusion. This mirage, while never rooted in reality, provides a false sense of hope that something is being done to create an environment that benefits the patient when in truth, it never was the case. Katz suggests that in order for something like informed consent to become real and not just a mirage, there has to be a certain level of action performed in both parties that make up the patient-physician relationship. Patients must desire to be more informed, an appeal to "patient self-determination," and physicians must allow for more discretion or the freedom to choose what must be done in any given situation.

Therefore, decision making within the medical field has to become a joint undertaking, dependent more on the quality and nature of the whole give-and-take process versus on whether a specific disclosure has been made or not. Doing this however, remains an increasingly difficult task thus leading to the mirage of informed consent. More so because doctors have always felt the responsibility of making decisions for patients themselves, instead of giving that decision or sharing that decision with the patient. "Physicians' apprehension of, and resistance to, breaking with their millennia-long tradition of solitary decision making express not only their understandable reluctance to depart from familiar practices ... doctors believe such problems should not be discussed with lay persons (Katz, 1984, p. 85).