Consent: radiologists' dilemma about contrast media

In February 1990 the Conseil d'évaluation des technologies de la santé du Québec released a report advocating the use of high-osmolar contrast media for "low-risk" patients. The authors of the report justified not mentioning to these patients, in the course of obtaining informed consent for examinations requiring intravascular contrast media, that there are two classes of contrast agent. Furthermore, they advocated concealing this policy from the public. In contrast, the authors of this article suggest that informed consent is the product of a dialogue between the consenting person (the patient) and the one requesting consent (the radiologist). Such a dialogue can exist only if the doctor gives the patient sufficient information so that the two are at the same level of understanding; the patient can then make an informed decision. These discussions are held in the name of equity. Three criteria that can be used to test for ethical equity--impartiality, reciprocity and "examplarity"--are discussed. The authors of this paper argue that a policy limiting access to low-osmolar contrast media is justifiable. However, concealing from the patient and the public the existence of a choice of contrast media is considered ethically indefensible.