Informed consent Medical/Patient for benefit or prejudice of the relationship?

1994/10/01 Alberdi, Fermin | Txoperena, Gabriel | Ibarguren Olalde, Karlos Iturria: Elhuyar aldizkaria

• Osasuna

As important as the explanation, diagnosis and treatment of the patient and/or their family members is the day to day of the doctor. Informed consent requires the signature of the patient or a family member who authorizes the technique or treatment. The most common example is blood transfusion: before putting blood the dangers involved are mentioned and the patient can authorize or deny with his signature.

The transmission of information is a right of the patient and a duty of the doctor. But how many information? With what purpose? Would it be logical for the commander of a plane to clarify where and with what strength comes the wind and its influence on engines, fuel consumption and flight? Would it be logical that, since we travel by plane and our life is in danger, they ask us permission to start the flight according to these data?

Throughout history, there have been different positions in this regard. For many years the doctor-sick relationship has been paternalistic. There was a trust relationship between the doctor and the patient, where the doctor knew and established the best techniques, diagnosis and treatment for the patient. The position that denies autonomy in decision-making, for example, is dominant in the European Mediterranean.

More information is currently requested to participate in the decisions. To this is added the judicial model that comes from the USA. And the ethical need to explain has become law. Although from an ethical point of view, informed consent may be issued verbally or in writing, it must be done in writing in the Spanish State in accordance with Article 10 of the General Law of Health. In some cases, the mere non-application for authorization can become a crime.

Once the information is incorporated, we consider positive that the patient expresses his opinion in important decisions. However, it is not easy to take steps in this regard: explaining what you have, from a point, can become very technical and generates more confusion than clarity in the majority of the population. It is impossible, moreover, to mention all the complications or consequences that a technique or treatment may have. Consequently, the most serious and frequent appear. In this sense, although the informed consent in principle is good, we see that its implementation raises some problems.

On the one hand, it produces an enormous bureaucratization of medicine. For any potentially dangerous intervention, a specific form must be designed and filled out. If a patient is going to have more than one intervention, she should read and sign many forms.

Secondly, it provokes anguish, anguish and doubt both in the patient and in the doctor. Society does not have the habit of doing something like this, so the mere firm makes it suspect that things can go wrong, generating distrust. The doctor is also not calm, since the decision can be different or different.

Finally, this measure is another aspect of the judicialization that the medical-sick relationship has had in recent years. In turn, it offers details on the path of the judicialization of the relationship. In practice, he manages to introduce in this relationship the figure of the third person: the lawyer. This undoubtedly provokes a defensive medicine. The objective is not to cure the patient, but to leave treatment with the patient without complaint. This includes unnecessary preventive diagnostic tests, hospital admission, treatments, etc. It takes us to finish. This, besides being harmful to the patient, is unsustainable for the public health system.