"I" Is for Information

By Margaret R. McLean

We are members of "the information generation." We literally have the world at our fingertips--newspapers, television, radio, the Internet. It's all about information, about what we know and how fast we can know it. There are few well-guarded secrets anymore; "informed sources" always seem to know everything.

How we deal with medical information is one of the most critical areas of bioethics. Two important ethical principles relate to the use of medical information--confidentiality and informed consent.

Confidentiality governs what professionals and institutions can do with what they know about us as patients. As patients, we trust that information about our health is shared only with those who need to know so they can care for our health and wellbeing. In a hospital setting where 60 or more people handle a patient's chart, the information it contains must be used fairly and wisely--to treat and to cure, not to discriminate or to blame.

Informed consent insists that we as patients need to be informed before we consent to medical tests or treatments. Being informed demands that we understand what is happening to us and why. Before we say okay to a test or treatment, we are told a number of things--why the procedure is being recommended, what to expect, possible side effects. If we are confused, we ask for clarification. If we need to know more, we say so. If we need time to consider it, we tell the physician we'd like to think it over.

Being informed is one thing; giving our consent is another. Giving consent requires comprehension, competence, and freedom on the part of the patient. We must adequately understand what we have been told. We must be capable of making a decision without undue pressure. We can even refuse a test or treatment--although it may be unwise to do so.

Ethicist Thomas Shannon claims that informed consent is the most central problem in bioethics. When do we know all we need to know? When do we say, "Go ahead" even though we are afraid? Informed consent is a process of conversation and negotiation between us as patients and the physicians and nurses who care for us. For our consent to be truly informed, we trust in the confidentiality of those who care for us and have confidence that we understand all that we need to understand in order to decide.

Margaret R. McLean is the director of biotechnology and health care ethics at the Markkula Center for Applied Ethics.

Return to The ABC's of Medical Ethics.

Posted in August 2006