Women in labor: some issues about informed consent

Women wishing hospital admission for childbirth are asked to sign very general pre-admission consent forms. The use of such forms suggests that women in labor are considered incompetent to give informed consent. This paper explores some of the problems with advance directives and general consent, and argues that since women in labor are not generally incompetent, it is not appropriate to require this kind of consent of them.     

The structure of informed consent in psychiatric research

The manner in which the informed consent process is structured was explored by means of intensive interviews with 17 experienced psychiatric researchers. Despite differing views on informed consent, investigators displayed a commonality of practice. Most investigators were themselves not usually involved in obtaining consents, relegating the process to lower-level assistants. They did not closely monitor the process and generally were unaware of problems that may have arisen. Most protocols called for repeat contact with patients so that a relationship would develop and information could be provided before obtaining a formal consent. The actual signing of a consent form often reflected a decision that had been made much earlier in the process. These findings have significance for both sides in the dispute over informed consent in research. Those who favor tighter controls over psychiatric research will have to consider the implications of monitoring, without destroying, a prolonged and complicated process. Those who argue for a reliance on investigators' integrity must deal with the apparent lack of involvement most investigators have in the consent process.     

Informed consent in the practice of group psychotherapy

Endorsed as part of ethical practice in group psychotherapy by professional organizations, informed consent is a process of communicating essential information about group treatment to patients so that they can make rational decisions about treatment-whether to enter and how to participate. Its benefits as well as necessary precautions are discussed. The design and implementation of the informed consent process for group is discussed in terms of who should obtain it, when it should occur, how it should be communicated, and what information should be considered for inclusion. Specific suggestions are included as well as a discussion of some potential ethical dilemmas.     

Participants' understanding of the process of psychological research: informed consent

Sixty-five undergraduates participating in a wide range of psychological research experiments were interviewed in depth about their research experiences and their views on the process of informed consent. Overall, 32% of research experiences were characterized positively and 41% were characterized negatively. One major theme of the negative experiences was that experiments were perceived as too invasive, suggesting incomplete explication of negative aspects of research during the informed consent process. Informed consent experiences were viewed positively 80% of the time. However, most of the participants had a limited view of the purpose of informed consent: less than 20% viewed the process as a decision point. Results suggest a number of common pitfalls to standard informed consent practices that have not generally been recognized. Results are discussed in terms of both ethical and methodological implications. Suggestions for improving the informed consent process are also provided.     

Treatment indication in psychotherapy: Some methodological aspects

In this paper it is argued that the general problem of indication, increasingly discussed in the field of psychotherapy in recent years, actually is a pseudoproblem with no solution to be expected. In its objectives and premises it is trongly suggestive of conceptions and ideas of early logical empiricism, to be considered as out-of-date today. The concept of indication is identified as ambiguous, and preliminary remarks aiming at an explication of the concept are made. Finally, the consequences of our arguments for the immediate problem of integration of the different therapeutic approaches are pointed out.     

The fair transaction model of informed consent: an alternative to autonomous authorization

The doctrine of informed consent in bioethics has relied on the view that consent is valid when it represents a patient or research subject's autonomous authorization. In this article we challenge this reigning conception of the validity of informed consent in clinical research, focusing in particular on the problem of the therapeutic misconception. We argue that the autonomous authorization model of informed consent suffers from four defects: (1) it fails to do justice to the relevance of risk-benefit considerations in shaping the criteria for the validity of consent, (2) it compromises the interests of subjects by preventing them from consenting to research participation with less than substantial understanding when doing so would likely be consistent with their preferences and beneficial to them or at least be unlikely to cause them harm, (3) it jeopardizes the interests of investigators by denying them fair notice regarding when the consent of research subjects can be considered valid and thus make it permissible for them to be enrolled in research, and (4) it threatens the reasonable limits on the responsibility of investigators to assure the adequacy of subjects' understanding of what research participation involves. In place of the autonomous authorization model, we present and defend a fair transaction model of informed consent, which better reflects the values served by consent.     

Routine screening: informed consent, stigma and the waning of HIV exceptionalism

The Centers for Disease Control and Prevention (CDC) recently recommended that HIV screening should become routine for all adults in the United States. Implicit in the CDC proposal is the notion that pre-test counseling would be more limited than at present, and that written informed consent to screening would no longer be required. If widely implemented, routine testing would mark a tremendous shift in the US HIV screening strategy. There are a number of considerations used to determine what screening tests should be routine, and HIV fits the bill in almost every regard. Yet the stigma associated with HIV infection remains, making the CDC's recommendation highly controversial. Will minimizing requirements for pre-test counseling and special written informed consent lead to unexpected or unwanted HIV testing, or do these stringent counseling and consent requirements needlessly scare people away? Will widespread and routine testing be associated with declining stigmatization, or will it drive some patients away from seeking desperately needed health care? These are high stakes questions, and we're about to find out the answers.     

论知情同意的中国本土化--中国文化视野中的知情同意走向

知情同意原产于西方,移植到中国后被"家文化"、"功利论"、"简单化"等中华传统文化彻底改造过以后,浓缩成了手术前一味要求病人家属或单位领导签字的行为模式,远离了知情同意的主旨,但曾一度非理性地普遍流行.现在,又出现了一种照搬欧美知情同意的倾向,在一线医务人员中引发了诸多困惑和不满.在实施知情同意时,离开中华文化语境,或者在本土化中化掉其本质的做法,都是不可行的.正确的取向只能是立足于中国当代医学实践,以正在形成中的中国现代文化去整合西方知情同意的本质、理念和规范,构建成一套适合中国国情的知情同意机制.     

Routine HIV testing of hospital patients and pregnant women: informed consent in the real world

The Centers for Disease Control and Prevention (CDC) has recommended that HIV testing be routinely offered to certain patients in hospitals with a high prevalence of HIV infection and on all pregnant women. The CDC does not, however, offer implementation level guidelines for obtaining informed consent. We provide a moral justification for requiring informed consent for HIV testing and propose guidelines for securing such consent. In particular we argue that genuine informed consent can be secured without elaborate counseling, such as that currently used at Counseling and Testing Sites, provided that sufficient written notice is given to the patients before testing and that they are specifically asked for permission.