Informed Consent, Personal Autonomy, Evidence Informed Practice and Health Care Mandates
During a time when paternalistic mandates in health care are expanding and the police powers of the administrative state are being used against large populations, patients are increasingly questioning their relationships with their doctors and the health care system.
As recently as 20 years ago the health care paradigm was undergoing a major shift in terms of how health care decisions are made. That shift was away from a paternalistic health care system where patients are subservient to (even afraid of) doctors and are supposed to do exactly what the doctor and the administrative state tells them. This paternalism was being replaced by a Patient Centered Model in which decisions about health care are made in conjunction with the patient’s desires, cultural values and that individual patient’s clinical state and circumstances instead of blindly relying on the authority of the doctor, government or other third party.
The widespread challenges to the Constitution and personal liberty that began 20 years ago set off a collision course with the issues of personal autonomy, consent and paternalism in health care. As a result, a significant portion of the population remain openly willing to trust the government with greater powers to conduct surveillance, mandate interventions and enforce police powers in the conduct of health care with its resulting loss of personal liberty.
In a more modern and enlightened patient centered model, the role of the doctor and the health care system is to help the patient make informed decisions through an evidence informed and consent driven process. The doctor’s job in this model is to make sure they are familiar with the research evidence related to the challenges the patient is facing and to help the patient understand if what is in the scientific literature matches what is happening to the patient. In other words: have people like me been studied? Do we know what works for my problem? One of the weaknesses of research is determining whether or not it applies to the individual patient sitting in front of the doctor. Further to this, when weighing decisions about what to do about a health challenge, one looks at the efficacy and the safety of the intervention based on the existing science. In the case of a new health challenge the safety and efficacy of an intervention may not have been thoroughly evaluated.
Once the question of what research exists for the intervention, its safety and efficacy and whether it applies to a person’s unique situation has been answered, then the next question to consider is whether or not the recommended interventions are consistent with their values as a patient, a mother, a father, a family etc. A particular treatment or intervention might exist for a particular patient that has been shown to be effective in the research literature but perhaps the intervention goes against the values held by the patient. Perhaps the patient is not satisfied with the level of efficacy or safety. The doctor’s role in all of this is to help the patient (or parents) navigate all this and make an informed decision.
It can be very difficult to think clearly about medical decisions when under stress and pressure from events that seem to be out of the individual’s control. Making matters worse in the case of many health challenges is that the evidence is not always very clear. Especially when it comes to things that are new and fear is driving the discussion.
The problem with mandates is that they completely remove the autonomy of the patient or the parent to make a decision on the evidence that does exist, its safety and efficacy, whether the intervention is consistent with their values and whether or not the evidence even applies to their particular clinical state and circumstances.
The paternalism and resulting control over people’s health care decisions goes so far as to say that what should be done is not what is in the best interest of the individual but what is in the best interest of society as a whole. This could mean being forced to subject yourself or your child to an intervention even though you don’t want it but purely because the administrative state demands that you do it for the perceived greater good.
The bottom line is that ultimately it is the individual’s decision whether or not to undergo a health care intervention. That decision comes about through an open, patient centered, evidence informed, consent driven process where the individual makes that decision knowledgeable about the evidence, comfortable with the intervention as safe, effective and consistent with their values. It is done with the help of a health care provider and system that honors their wishes so that no one is forced to sacrifice their personal autonomy due to the beliefs of another. This is a truly patient centered, autonomous, evidence informed, consent process that everyone must expect and honor.
Matthew McCoy DC, MPH
CEO & Co-Founder
Anthony Carrino DC, FICPA
President & Co-Founder
