Informed Consent as Societal Stewardship

Abstract

In the landscape of American health care in the twenty-first century, individual patients’ medical decisions can no longer be viewed in isolation. Each treatment decision a patient makes is situated within a much broader societal context, and thus contributes to population-level trends that have an impact on all health care consumers. In the public health sphere, for example, individual decisions about whether or not to vaccinate can contribute to the resurgence of communicable diseases that were until recently considered eradicated. At a systemic level, individual decisions to pursue resource-intensive treatments can contribute to the rising societal costs of health care, higher insurance premiums, and increases in governmental expenditures on Medicare and Medicaid.

The process of obtaining a patient’s informed consent has traditionally involved the disclosure of information about medical risks and benefits. But in an era when patients’ health care decisions also affect society as a while, should physicians’ ethical obligations change? This article examines whether the informed consent conversation should be viewed as an opportunity to position patients as societal stewards, by sharing information about the impact a patient’s choice of treatment may have beyond her own health.

[SSRN version posted is a pre-publication draft]

Note: SSRN version posted is a pre-publication draft.

Keywords: informed consent, public health, health care costs, justice, autonomy, patient responsibility, medical ethics