Informed consent and the elderly patient

Achieving a moral informed consent from a patient is certainly no easy task for the physician. Patient autonomy has become a watchword of the medical profession and has promoted to some extent an emphasis on the idea of noninterference with the patient as the essential feature of the physician's respect for this autonomy. This is unfortunate because noninterference in many instances really does not take into account the transforming effects of illness and their impact on informed consent. In illness, the body is interposed between us and reality, and it impedes our choices and actions and is no longer fully responsive. Illness forces a reappraisal and in doing so opens up old anxieties and imposes new ones, often including the real threat of death or drastic alterations in lifestyles, such as becoming ventilator-dependent. Fear alone may cripple the ability of the patient to choose. In any consideration of informed consent, the extent of the patient's illness and suffering must always be considered. Adequate interaction with the elderly patient that is necessary for an informed consent consists of a combination of "objectivity" and "cooperation." Cooperation is shown by psychologically reproducing in the mind of the doctor, insofar as possible, the meaning the patient's illness has for him. Without such knowledge, the physician cannot assist a patient in restoring some control over his life, or in understanding his values, both of which are so essential in the decision-making process. The meaning of informed consent is vacuous at best without this objectivity and cooperation. Along with this interaction, the elderly patient must be placed in such a position that throughout his illness he maintains a free choice to decide while he is mentally able to do so. Simply knowing that this freedom exists removes many of the doubts and fears constraining the patient's own sense of autonomy. As a final statement regarding informed consent, we should note that any success by the physician in dealing with problems surrounding the patient's informed consent is always central to the strength of the physician's relationship with the patient. Because of the changing features of this relationship today, the physician should always be ready to implement the steps necessary to maintain the integrity of that relationship. The covenant of faithfulness demands nothing less.