Informed Consent to Treatment

Description of the Strategy

The doctrine of informed consent requires that a client be informed of potential benefits and risks of contemplated treatments, expected prognosis with and without treatment, and any possible alternative treatments, prior to entering treatment. Underlying the doctrine of informed consent is the principle of autonomy, the idea that a client's life and treatment should be self-determined.

Three elements are necessary for consent to be truly informed, and all three elements must be present for consent to be valid. The three elements are intelligence, knowledge, and voluntariness. Intelligence, sometimes referred to as competency, is defined as a client's legal capacity to comprehend and evaluate the specific information that is offered. Unless otherwise deemed by the courts, adults are considered legally competent to understand information and to make medical decisions concerning their health. Children, on the other hand, typically are not considered competent and cannot give valid informed consent. Instead, consent for treatment of a minor must be obtained from a legal guardian or parent. It should be noted that some state statutes recognize the matureminor exception, granting the right to consent to treatment to minors near the age of majority or mature enough to understand and weigh treatment options.

Knowledge, the second element of valid consent, is defined as a client's ability to appreciate how the given treatment information applies to him or her specifically. Knowledge is not a presumed legal capacity to comprehend information, but instead must be assessed by the clinician with each individual client throughout treatment.

Voluntariness, the third element of valid consent, suggests that a client's consent may not be coerced or enticed by the treating agent. For example, clinicians may not promise miraculous cures, nor should they offer financial incentives for participating in treatment. Clinicians should also inform their clients that they may withdraw from treatment at any time. Finally, there are ethical constraints as to the extent to which a client can voluntarily consent. For example, a therapist cannot justify sexual acts with a client by claiming that the client voluntarily agreed to these acts as part of treatment.

Legal and Ethical Bases of Informed Consent

Initially, informed consent was a legal concept applying only to physicians and surgeons, requiring doctors to tell patients the type of treatment recommended. Within the medical community, the concept eventually was expanded in scope, requiring physicians to provide information about all available treatments so that patients could make educated decisions as to whether to accept a particular form of treatment. Largely because psychotherapeutic techniques lack the physical invasiveness inherent in surgery and many other medical procedures, informed consent initially was not required for psychotherapy. However, as psychotherapy increasingly has become accepted as a [Page 338]legitimate medical procedure by third-party payers and the law, legal requirements such as informed consent to treatment have been imposed on therapists to the same extent as on other health care providers.

Even prior to legal mandates, ethical codes developed by the American Psychological Association (APA) and the American Counseling Association (ACA) required clinicians to obtain informed consent for treatment. The overarching principles espoused in these ethical codes are that clinicians must consider each client's best interests, autonomy, and self-determination.

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