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Universal Consent for Invasive Procedures in the Intensive Care Unit
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To the Editor: Ms Davis and colleagues1 studied the effects of providing a "universal consent form." Patients or their proxies were asked to provide anticipatory consent at the time of admission to the intensive care unit (ICU) for 8 different procedures that they might later undergo. The authors claimed that this intervention increased the rate of informed consent relative to a baseline period.
The concept of informed consent, however, has 2 somewhat contradictory meanings that the authors did not distinguish: first, a legally important consent document; and second, a morally important ongoing dialogue between patient or proxy and the physician. Aspects of this latter meaning include information, understanding, and noncoercion.2 While Davis et al argued that their anticipatory procedure is expedient for obtaining written consent, I am concerned that it could jeopardize ongoing discussion. Medical decisions are generally made in real time as the clinical situation unfolds, not prospectively. The . . . [Full Text of this Article]
Don Milmore, MD, MA
Center for Bioethics and Humanities
SUNY Upstate Medical University
Syracuse, NY
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