Arnold & Lidz on Consent (in Levine, Taking Sides, 11th edition)

EVENT MODEL dominates medicine:

Provision of info and signed consent are combined in a single event, usually immediately prior to start of invasive treatment. (avoids legal charge of battery if patient objects)

Currently, professionals control the consent process, minimizing client participation.

Problem: Genuine respect for autonomy requires that patients determine their level of involvement. (Patients can trust judgment of doctor, but need not do so.)

PROCESS MODEL would maximize client participation.

Every party in the process contributes to the dialogue.

Two important decisions are PRIOR to current consent procedures:

Decision what problem exists, then choice of reasonable goals (Neither of these can be assumed to be identifiable by the medical professional)

Four additional constraints:

• Information must be understandable to the client,

• Weight assigned to the importance of the decision (relative to client’s situation & goals),

• Degree of professional consensus among professionals about proposed course of action,

• Continual updating of progress, with openness to revising goals.