Question

How does informed consent differ between health care and mental health?

It is imperative that the answer is cited so please cite the answer

Answer 1

Initially, informed consent was a medical concept applying only to physicians and surgeons. The concept was circumscribed, requiring only that doctors tell patients the type of treatment recommended. Within the medical community, the concept eventually was expanded in scope, requiring physicians to give patients enough information about different available treatments so that patients could make educated decisions as to whether to accept a particular form of treatment. More recently, the concept has been incorporated into other disciplines, such as psychology. Clinicians have an ethical and often legal obligation to obtain consent from clients prior to treating them. In order to obtain valid consent, clients must be fully informed regarding the nature of psychotherapy, including, for example, the potential benefits and risks of treatment, alternative treatments available, and limits of confidentiality. Several legal cases illustrate the importance of obtaining informed consent. The first major legal statement of the need for consent occurred in the 1905 case of Mohr versus Williams. In this case, the plaintiff used a physician for performing an unauthorized surgical operation. While the plaintiff did consent to an operation on her right ear, the physician instead performed an operation on her left ear, as he had found the left ear to be more in need of treatment once the surgical procedures had commenced. Following the operation, the plaintiff claimed that she had not previously experienced any difficulty with her left ear but that she currently was having trouble hearing out of that ear. The court found in favor of the plaintiff and stated that a surgical operation by a physician upon the body of his patient is unlawful when performed without either the express or implied consent of the patient.

The current doctrine of informed consent requires a client to be informed of the potential benefits and risks of the contemplated treatments, the expected prognosis with and without treatment, and any possible alternative treatments. Barring exceptions such as emergency treatment, a person cannot be given therapy without his or her informed consent to such procedures. Underlying the concept of informed consent is the principle that allowing a client to make an informed decision respects that person’s autonomy and self-determination.

In mental health care a valid consent implies that the client agrees to treatment intelligently, knowingly, and voluntarily. Intelligence, sometimes referred to as competency, is defined as a client’s capacity to comprehend and evaluate the specific information that is offered, whereas knowledge is defined as a client’s ability to appreciate how the given treatment information applies to him or her specifically. Finally, the voluntary element suggests that a client’s consent may not be coerced or enticed by the treating agent. All three elements must be present in order to consider consent truly informed and valid. Given the three elements of valid consent, it should be clear that obtaining informed consent is not a one-time incident but instead is an ongoing process throughout treatment. Several authors have suggested that clinicians adopt a process model rather than an event model of informed consent. Ongoing discussions with clients throughout the treatment process may be necessary to ensure that they have sufficient opportunities to ask questions and have information clarified. At a minimum, there are two discrete times during the therapy process when informed consent should be obtained: at the initiation of therapy and when particular treatments are proposed. Obtaining informed consent of all clients is an ethical requirement for psychologists. In addition, it is likely that psychologists will increasingly be legally required to obtain informed consent prior to treatment.