Informed Choice and Informed Consent

Afr. Am. woman with doctor
What is informed choice or informed consent?

In health care, a person with a health problem may be given options to choose from several diagnostic tests or treatments, or they may choose to have no treatment. This is called “informed choice.” If the person agrees, she gives “informed consent” to the test or treatment she has chosen.

If you are pregnant, you have a responsibility to yourself and your unborn baby to make informed decisions about your pregnancy, childbirth, and the time after birth. The decisions you make influence the type of care you receive. Informed choice leaves you, not your caregiver, as the primary decision maker, in contrast to the traditional medical model of informed consent that leaves the choice of possible treatment in the hands of the health care providers.

It is important that you understand the reasons why a test, procedure, drug, or intervention has been recommended. Although they may be things that are done routinely, you will want to determine for yourself whether they are right for you. To assist you with your decision, you should be made aware of how you are likely to be affected, including side effects such as pain or discomfort, or the ways your daily routines may be affected.

Informed choice is a process to help you determine what you want done to you and your baby. Informed choice also gives you the following rights and responsibilities:

  • the right to self-determination
  • the responsibility to keep yourself and your children safe from harm
  • the right and responsibility to decide what options are best for you and your baby
  • the right to clear and complete explanations about your care
  • the right to have your questions about your care answered
  • the right to request and receive a copy of your medical records
  • the right to ask for a second opinion
  • the right and responsibility to decide whether to accept the care you are offered

When making informed decisions about your pregnancy, childbirth, and the time after birth, you need to consider the following:

  • What options are available to you?
  • What are the needs and preferences of yourself and other family members?
  • If you prefer another option that is not available to you through your current caregiver, are you willing to switch to another caregiver who does offer the type of care you want?

It is important that you discuss the various options with your health care provider at some time before you go into labour. During labour, you may be distracted or not have time to listen carefully to the explanations given for the proposed test, procedure, medication, or intervention. Preparation of a birth plan prior to labour allows you to combine your wishes for childbirth with what your health care provider thinks is practical.

If you are a teenage mother, it is important for you and your family to realize that there is no official age of consent for medical procedures. Therefore, you are the one who should make decisions about procedures that will affect your body and your baby. Your parents cannot make these decisions for you, although you may want them to help you. Sometimes this is a difficult concept for parents of teenage mothers to grasp. Your health care provider will help to make this point clear.

What does informed consent to undergo a procedure or intervention such as surgery involve?

Consent to a procedure is considered “informed” only after you have been given the following information:

  • a description of the procedure
  • benefits and risks of the procedure
  • how the procedure may affect your baby
  • any reasonable alternatives to this procedure
  • what will happen if this procedure is not done

Consent before surgery or other treatment is an example of the informed consent process. Before you are scheduled for a procedure or surgery, you need to decide whether or not the doctor can go ahead. The doctor will discuss with you the risks involved with the surgery, treatment, or procedure under anaesthetic before you sign a consent form. She is required to tell you about any potential problems that could occur and to ensure that you understand the general nature of the procedure.

This discussion provides an opportunity to ask any questions you may have about the procedure or express any concerns you have.

In the case of surgery and some other procedures, by signing the consent form you will also be consenting to the use of anaesthetic if necessary. At some hospitals, you may be asked to give a separate consent for the use of anaesthetic. Usually you are also agreeing to any additional investigation or treatment that the doctor may decide is immediately necessary during the surgery. This would only happen if the doctor finds something she was not expecting to find, and needs to do something about it right away.

What are your caregiver’s rights?

Your caregiver has rights too. She has the right to agree or disagree to provide care that you request. For example, if you request a planned caesarean section for the sake of convenience, your doctor has the right to refuse to do so. If she is unwilling to be your doctor, she should help you find another one.

In the case of an emergency, when treatment cannot wait and there is no time to obtain informed consent, the doctor can decide whether to go ahead without consent. This decision is recorded in the patient health record.

What does informed consent to take part in research or a clinical trial involve?

You may be asked to decide whether or not to take part in a research study or a clinical trial. The person asking you to make this decision must make certain you have a full understanding of the purpose of study, the results expected, how the study works, any risks or benefits, and in the case of a clinical trial, the other treatments available. You may ask questions about the study and receive information about the results when the study is finished.

After explaining this, you will be asked to make a decision about taking part in the study. To give consent to take part, you will sign a consent form describing the research and the risks and benefits.

If you decide not to take part in a research study or clinical trial, you and your baby will continue to receive the same quality of care from the health care team and the hospital. If you do decide to take part in the study or trial, signing a consent form is not a contract. You can change your mind, withdraw your consent, and leave the research study or clinical trial at any time. If you decide to withdraw your consent, you and your baby will continue to receive the same quality of care from the health care team and the hospital.

Christine Newman, MD, FRCPC

Nicolette Caccia, MEd, MD, FRCSC

Zan Manning, RN, JD, MA