Background In Fast Fact #164, the legal basis for the informed consent process was reviewed; this Fast Fact discusses common myths about informed consent that arise in palliative care. Readers wishing more information should read the excellent review by Meisel and Kuczewski.

Myths:

1. Myth: Federal or state laws require written informed consent (patient signature) for invasive procedures. FALSE: The use of signed consent forms is decided by local hospital or institutional or accrediting organization policies. They are generally not mandated by law or federal/state regulation. Note: state law may mandate written consent for certain tests or high-risk treatment (e.g. HIV, genetic testing, or electroconvulsive therapy) and federal law may require written consent in some circumstances (e.g. transfers from emergency departments). Signed consent forms may not shield the physician from claims of negligence due to failure to provide informed consent if the physician did not fulfill the informed consent process (see Fast Fact #164).
   
   
2. Myth: No informed consent is necessary for patients admitted to a hospital in transfer from a nursing home, of for patients transported to the hospital following a 911 call. FALSE: There is no “implied consent” just because 911 or a transport ambulance was called; such patients require the same level of informed consent discussions for medical care decisions as any other patient unless the medical situation satisfies the criteria for the emergency exception (see Fast Fact #164).
   
   
3. Myth: No informed consent is necessary when starting “low risk” life sustaining treatments such as IV antibiotics, intravenous hydration, feeding-tube placement, or blood products. FALSE: All these treatments represent interventions with risks and alternatives. An informed consent discussion is especially needed in seriously ill or dying patients where the option of no intervention is a reasonable choice; the failure to discuss not using life sustaining intervention represents a failure to provide full informed consent. Also, patients should be informed that if a life sustaining treatment becomes too burdensome (a risk of any treatment), the patient may withdraw his or her consent and the treatment will be withdrawn. Of note – the same principles apply to the informed consent process around cardiopulmonary resuscitation (CPR).
   
   
4. Myth: Informed consent means that patients should choose among medical option without clinicians introducing their bias toward one specific option. FALSE: The clinician’s obligation is to present medical information accurately to the patient or to the individual responsible for the patient’s care and to make recommendations for management in accordance with good medical practice. The clinician has an ethical obligation to help the patient make choices from among the therapeutic alternatives.
   
   
5. Myth: An informed consent discussion needs no special documentation except in cases of invasive procedures. FALSE: Even if not legally required, the content and outcome of an informed consent discussion should always be documented in the medical record and include the elements noted in Fast Fact #164 as an indication that the ethical and legal requirements of the process of informed consent have been fulfilled.

References

1. Meisel A, Kuczewski. Legal and ethical myths about Informed Consent. Arch Int Med. 1996; 156:2521-2526.
2. Brett A, Rosenberg JC. The adequacy of informed consent for placement of gastrostomy tubes. Arch Intern Med. 2001; 161:745-748.
3. American Medical Association. Informed Consent. Available at: Informed Consent | AMA-Code.
4. American Medical Association. AMA Withholding or Withdrawing Life-Sustaining Medical Treatment. Available at: Withholding or Withdrawing Life-Sustaining Treatment | AMA-Code.

Version History: Originally edited by David E Weissman MD and published in October 2006; 2nd Edition in April 2009; 3rd Edition in July 2015; 4th Edition in October 2024 after being reviewed and edited by James Deming MD.
Conflicts of Interest: None to report