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Lemuel Shattuck Hospital Boston MA 02130-3782
From time to time, physicians of most specialties come across patients who are earnestly willing to have an interventional procedure performed, but express clearly their desire not to be informed of the risks, benefits, or alternatives. On the other hand, clearly, a patient has a right to be informed before undergoing surgery or another interventional procedure, and the clinician who is to do the procedure (or a designated physician) has an obligation to provide the patient a genuine opportunity to learn the relevant facts [1,2,3,4,5]. So how does an operating surgeon, radiologist, or other clinician properly handle the patient who says, "I just want you to do the procedure. Don't tell me about the risks, Doc; I don't wanna know!"
Such patients are not rare in our department. However, the situation is rarely discussed and the legal aspects are not widely known among clinicians, regardless of specialty. Certainly, physicians do not want to subject themselves to the risk of a malpractice claim. So what is the physician to do?
Just as patients have a right to know what they need to know to make a reasoned decision, they also have the right not to know [1, 3]. Each of these choices is a manifestation of the autonomy of the patient, and the physician has legal and ethical obligations to respect either expression of that autonomy [1, 4]. Indeed, forcing a patient to hear of the risks when the patient has already made explicit his or her desire not to know is a violation of the patient's dignity [1].
If a patient makes clear her or his desire not to be informed, it is legal and proper for a physician to undertake the procedure without giving the patient all of the details [1,2,3, 5]. As well, the patient can elect to terminate the process of being informed at any point, and thus be only partially informed before giving consent [1]. In such a setting, the fact that the patient is not informed (or not fully informed) is at the request of the patient; the patient is providing consent, but being informed has been waived by the patient [1,2,3].
I term this "patient-requested noninformed consent," and it is legally valid [1,2,3]. (It is one of the few situations in which informing the patient is not necessary [2, 3, 5].) However, a physician would be well advised to document clearly the patient's election not to be informed [3, 5]. In our department, the patient's choice to be or not to be informed is clearly indicated on the consent form, which is signed by the patient (or by her or his legal representative). All patients in our department who are to undergo a procedure that requires formal documentation of consent thus indicate their choice on the form. Although this election need not necessarily appear upon the consent form per se [5], explicit documentation of the patient's choice not to be informed is advisable [3, 5].
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