Ethical and cultural dimensions of informed consent. A case study and analysis

A case of a patient with angina who was considered for coronary bypass surgery illustrates the issue of informed consent. Ethical and legal aspects and the inherent limitations of achieving consent must be considered. Physicians may have personal biases, which may lead to coerced consent, or may overwhelm the patient with information on potential complications of a proposed procedure, which may lead to consent without hope. Patient bias or misinformation may lead to misunderstood consent or, if the patient's judgment is distorted, to crisis consent. The patient's desire to defer the decision to the physician raises the question of whether such requested paternalism violates patient self-determination and invalidates consent or is an exercise of the patient's right to have his physician decide. The case presented exemplifies the patient-physician interaction needed for responsible paternalism.