The Role of Unconscious Conflict in Informed Consent

TLDR: Informed consent refers to the requirement that a patient be apprised of the nature and risk of any medical procedure before his/her physician can claim exemption from liability for damages to him/her.

Abstract: Informed consent refers to the requirement that a patient be apprised of the nature and risk of any medical procedure before his/her physician can claim exemption from liability for damages to him/her. If a patient has not given a voluntary informed consent, a medical procedure is deemed to be unauthorized and recovery for damages may result. Under conditions of emotional or intellectual limitation, or of medical emergency, the central problem of informed consent becomes that of assessing the degree to which individual well-being is furthered by individual autonomy as opposed to medical paternalism.· Efforts to formulate a comprehensive legal doctrine of informed consent inevitably have certain assumptions about the role of information and rationality in the exercise of free choice. The operational legal system assumes that normal adults primarily rely upon a logical approach to decision making. In other words, that data are collected, compared, in­ stances recalled, and analyses undertaken of risk versus benefits with physician assistance, ultimately leading to conclusions about various treat­ ment alternatives upon which a patient's decision is based. Naturally such an accomplishment requires a collaborative physician/patient relationship and some discussion beyond mere written consent. What little research on this subject exists is far from conclusive but seems to dispute this view of rationality and lend support to ideas of a less logical basis of decision making. 2 Even in those instances in which efforts are made to ensure a sympathetic, communicative environment, the nature of human thought process and emotion, some of which is universal and some of which belongs to either individual character or acute stress reactions, will heavily influence patients' decisions. 3 Law and psychoanalysis both value personal autonomy. Law attempts to secure it by eliminating social injustices and psychoanalysis by overcoming the instinctual domination of rational thought. Common aims are pursued differently. The law regards a social context, the analyst regards an internal equilibrium of psychologic forces. The law's unease with the subjective question of a patient's personal comprehension has led to the prevalence of the Canterbury Standard 4 of consent based upon what a "reasonable person"