Comprehension of

information
 In order for a consent to be valid, the patients must be able to
comprehend the information being conveyed.
Lack of sufficient information can limit comprehension
Presentation of information in a distorted way and in unsuitable
circumstances may mean that comprehension failed to occur
People who choose to know less information than a reasonable person

Robert Veatch anyone who refuses to accept as much information as

the reasonable person would accept cannot be said to have
apprehended the relevant information and therefore cannot be said to
have given an acceptable consent at least not to involvement in
research
Alternative Ways
When a reasonable-person standard is not being met, the procedure
cannot be done until sufficient information has been imparted, not
withstanding the patients autonomously expressed desire not to be
informed.
 When a patient or subject has been sufficiently informed to know
whether or not further information is wished, and when the right to
further information has been waived, no further information should
be provided.
 To allow or not allow waivers.. That is the question
Problem 2
When patients reach their decisions based on irrelevant grounds even
though they have been adequately informed
 So should a person be coerced into giving up their false beliefs and
irrational tendencies and decide on the basis of pertinent information
alone
 H. tristram Engelhardt
One cannot try to force subjects who are rational free agents to
use rationality and freedom to its fullest

Informed consent only entails that the patients make their own free
and rational assessments
 Robert Veatch
when subjects specifically object to further information, the
information should not be imposed to them
VOLUNTARINESS
Ability to choose ones own goals

Exercising choice about an action free of coercion or undue influence

by another person
REFUSAL TO TREATMENT
Patients can refuse treatment

Refusal of medical therapy necessary to sustain life

Patients Bill Of Rights
The patients has the right to refuse treatment to the extent permitted
by the law and to be informed of the medical consequences of his
action
 Case: Patient with intestinal bleeding refused blood transfusion
Why: religious Beliefs
Court decision: Move to accept the patients choice on the ground
that bodily SELF determination is an inviolable right
Free exercise of religion(In re Estate of Brooks)
CASE 1
Jehovahs witness refused blood transfusion for her and fro her
daughter (1st party refusal)
Her husband also refused blood transfusion for his wife and daughter
(2nd party refusal)

Decision: Judge refused to order transfusion for the woman but not
her new born daughter
 Informed consent functions to protect the right of autonomous
choice for competent individuals but also functions to protect
incompetent individuals form harm
Georgetown college case
A 25 year old mother with a 7 month old child refuses transfusion
because of religious beliefs

Resolution: the patients fundamental constitutional right to the free

exercise of her religion was overridden by the states interest in
preserving her life
Limitations
This approaches does not consider hard cases of 2nd party refusals
Almost all court cases and many common hospital scenarios involve
patients of questionable capacity to consent
 In cases where persons are acting irresponsibly thereby hurting
another person (dependent), their decisions may be overridden, even
when informed and voluntary