Informed consent for medical treatment and research: a review.

The practice of informed consent has historical roots in various disciplines, including medicine, moral philosophy, and the law. It is closely tied to philosophical notions of respect for persons and respect for individual autonomy. Consent to treatment is rooted in case law. Consent to research, in contrast, has its basis in ethical codes, statutes, and administrative regulations, with the courts playing a lesser role. In this article, we define the elements of informed consent in the treatment setting, outline its ethical and legal foundations, and explore some of its limitations. We contend that informed consent plays a critical role in clinical medicine but that other models of decision making deserve consideration under particular circumstances. We also delineate the current federal regulatory schemes guiding human subject research in the U.S., highlight how consent to research differs from consent to treatment, and explore the difficulties that arise in research involving cancer patients and certain vulnerable populations.

[1]  G. Bach-y-Rita The prisoner as an experimental subject. , 1974, JAMA.

[2]  L. Roth,et al.  Toward a model of the legal doctrine of informed consent. , 1977, The American journal of psychiatry.

[3]  T. Beauchamp,et al.  Principles of biomedical ethics , 1991 .

[4]  Jay Katz,et al.  The Silent World of Doctor and Patient , 1984 .

[5]  J. Drane,et al.  The many faces of competency. , 1985, The Hastings Center report.

[6]  T. Beauchamp,et al.  A History and Theory of Informed Consent , 1986, American Political Science Review.

[7]  E. Perez-stable,et al.  Hispanic Familism and Acculturation: What Changes and What Doesn't? , 1987 .

[8]  Paul S. Appelbaum,et al.  Informed Consent: Legal Theory and Clinical Practice , 1987 .

[9]  P S Appelbaum,et al.  False hopes and best data: consent to research and the therapeutic misconception. , 1987, The Hastings Center report.

[10]  E. Emanuel,et al.  Four models of the physician-patient relationship. , 1992, JAMA.

[11]  B. Freedman Offering Truth: One Ethical Approach to the Uninformed Cancer Patient , 1993 .

[12]  F. Goodwin,et al.  The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. , 1993, Archives of general psychiatry.

[13]  S. Murphy,et al.  Ethnicity and attitudes toward patient autonomy. , 1995, JAMA.

[14]  L. Rhodes,et al.  Western bioethics on the Navajo reservation. Benefit or harm? , 1995, JAMA.

[15]  G. Annas Questing for grails: duplicity, betrayal and self-deception in postmodern medical research. , 2017, The Journal of contemporary health law and policy.

[16]  M. Pang Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. , 1999, Journal of medical ethics.

[17]  Steven Joffe,et al.  Quality of informed consent in cancer clinical trials: a cross-sectional survey , 2001, The Lancet.

[18]  P. Appelbaum Involving decisionally impaired subjects in research: the need for legislation. , 2002, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[19]  E. Emanuel,et al.  Ethics in Oncology , 2003 .

[20]  D. Drotar,et al.  Communication of randomization in childhood leukemia trials. , 2004, JAMA.