Conclusions

The purpose of discussing risks, benefits, and alternatives with patients is twofold. First, it demonstrates respect for the individual and enhances his or her capacity to act in an autonomous manner in line with his or her own values. This means that the outcome of the process of discussion is for the individual him- or herself. Except in very rare cases, information should not be withheld because it might lead to the patient's rejecting treatment, because if the information resulted in a rejection of treatment then clearly it is relevant to the patient. The therapeutic imperative should not dominate to the detriment of the rights of the patient.

A second purpose of information disclosure is that, if it results in an agreement to proceed with therapy, it renders what would otherwise be an assault lawful. Where adequate information has been given, the doctor may undertake procedures which could otherwise result in criminal charges. Equally, the doctor will not be liable under the civil law of negligence where the required amount of information has been given.

Therefore discussion protects both patient and doctor, and will most likely enhance the relationship of trust between the parties which is so essential to the 'good' practice of medicine. However, few legal systems, if any, are absolutely clear about just how much information needs to be given. In countries where the doctrine of informed consent exists, the amount of information required may be greater than those (such as the United Kingdom) where this doctrine plays no formal role. However, people's moral standing does not change with geography nor with the nature of their illness and, irrespective of the legal tests laid down, each person is entitled to the fullest possible relevant information on which to base his or her decision.

The principles of medical ethics are designed to ensure that patients are not harmed by their involvement with medicine and that they are prioritized in terms of respect. Harm, of course, need not merely be physical. Harm, both ethically and legally, may be no more than disrespect resulting from inadequate discussion. Legally, compensation may be obtained even where the failure to respect the patient's wishes results in a good clinical outcome ( Malette v. Shulman (1990) 67 DLR (4th) 321 (Canada)). This is because the values which underpin medicine are greater than technical capacity. In judging what information a patient should receive, doctors would do well to bear this in mind, since '.it can be concluded that patient autonomy is only protected where there is a meaningful choice made by the patient, on the basis of adequate information, about which of the available therapies is acceptable and as to whether or not to participate in any therapy at all'

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