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Rethinking Informed Consent

Peter H. Schuck
The Yale Law Journal
Vol. 103, No. 4 (Jan., 1994), pp. 899-959
DOI: 10.2307/797066
Stable URL: http://www.jstor.org/stable/797066
Page Count: 61
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Rethinking Informed Consent
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Abstract

Impending changes in the U. S. health care system invite us to reconsider and reform the law of informed consent. What do patients really want to know about a proposed course of treatment? Should physicians' legal obligations to disclose be expanded, retained in their present form, or reduced? Where informed consent is concerned, is the gap between the law "in the books" and the law "in action" deplorable or instead a source of insight? How can risk information be communicated to patients more effectively? Professor Schuck seeks to illuminate these questions and to suggest answers by comparing informed consent in the health care setting with its analogues in other areas of tort law, especially products liability. The doctrine of informed consent in health care, he finds, imposes different and generally more onerous responsibilities on risk creators than non-health-care analogues impose on them, a disparity that is not clearly justified by considerations of autonomy, relational continuity, conflict of interest, information and power inequalities, or utility. Since all of the justifications for informed consent ultimately depend on how physicians and patients use it, Schuck urges that the doctrine be reassessed with special attention to its actual consequences. He recommends, first, that informed consent doctrine be subjected to an analysis of its cost-effectiveness, a question that has been largely ignored in the extensive empirical research on informed consent. Second, physicians should describe risks in comparative terms so that patients can view these risks in the light of other, more familiar ones that they face in daily life. Third, the now-monolithic informed consent doctrine should be contextualized and thus differentiated. Finally, the law should foster this differentiation by facilitating and enforcing provider-patient contracts about the level and characteristics of informed consent.

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