Who is Protected by Informed Consent?

Written by:  Ryan Pferdehirt

Harvard University cardiovascular surgeon Hooman Noorchashm has been on a campaign to raise awareness about the dangers of a common gynecological procedure, power morcellation. Used on his wife, Dr. Amy Reed, during a routine hysterectomy, she then developed cancer. Noorchashm says that this procedure contributes to the spread of cancer cells. Even after an FDA warning, major healthcare providers like UPMC and AHN continue to use the procedure on patients that they determine would benefit. Healthcare providers say patients are informed and consent to the risks before the procedure (estimated 1-in-350 risk of developing cancer with use of power morcellation) —  Dr. Noorchashm calls this informed consent policy “ethically flawed.”

That raises good questions about informed consent: Who benefits most? And whom is it meant to protect — the patient or the hospital?

Informed consent is seemingly derived from the principles of autonomy, to ensure that patients understand risks involved in procedures so they can make the most educated decisions regarding their own health. But informed consent developed from the laws of battery, requiring a person to allow being touched . . . more legal function than ethical? Dr. Noorchashm says that informed consent protects the hospital by removing liability rather than protecting the patient’s safety and health.

So, should physicians perform procedures carrying substantial risks on consenting patients—consent that may be given while vulnerable and with limited medical understanding? How about when less risky procedures could be used?