Informed consent: A balanced approach between medical paternalism and patient autonomy is a good legal safeguard

For centuries, medicine has been practiced both as an art and a science. In an art form medicine deals with feelings, emotions and human interactions. In actuality, it is a very powerful scientific tool to ever have been discovered or mastered. It is very potency lies in the fact that it deals with human beings; their sufferings and ultimate mitigation. If followed in the most scientific manner, this tool can enhance human life and its qualities. However, this scientific innovation gives the most potent power in the hands of its practitioner, i.e., the power of saving life. This power of ascendency has always been used with utmost care, reverence, and for the benevolence of the sufferer. In the patient–doctor relationship, the physician is assumed to be a “Pater” or a father figure to guide the patient in choosing the correct path to good health. This relationship is most useful in the inebriated state during disease, which not only clouds the patient’s facultative instincts but also those of the relatives who are not in a state of mental rationality, given the gravity of the situation. At this time of clouded consciousness, the only sane person to give the correct guidance is the treating physician. The patient–doctor interaction and the relevance of a comprehensive treatment are facilitated by the impugned consent of the patient to receive the appropriate therapy for healthy outcome. With Beauchamp’s advocacy for more patient compliance and an increased feministic, liberalistic approach of maintaining the integrity of patient, a well-informed reasoning and the decision taken thereto, becomes the most relevant and rational approach.[1] This in actuality helps to preserve the sovereign right of the patient over his body. From cultural relativism and pragmatist view, a liberal suffering from bad fever or a fractured limb would never consult a traditional healer to a modern physician just to prove his obsequious views. Therefore, it is submitted that medicine, is a world of unmistakable power, where the learned few, through their reasoning capabilities and higher educational knowledge have partially more significant hold on the “others.” Medical history is not only that of a power in progress but also an emergent conflict state between society and economics. Power at the most rudimentary personal level originated in dependence and the power of the profession originates from the dependency on knowledge. The physicians offer individualized objectivity, personal relationship as well as authoritative counsel. When professional claim to be authoritative about the nature of reality, the conscious thinking, or the world, one generally defers to their judgment. In order to square the faulty line lying in an absolutist view, guided paternalism can be a way out for informed consent. This gives a more moralistic equivocal and utilitarian approach from the patient’s point of view.[2] Hence, to safeguard against the accusation of meddling of individual freedom and self-rule through different contentions, a well-informed decisive consent is a better walkthrough. This is exemplified through damage rule, welfare, guidelines of legitimate moralism, and the intent to stability. This approach also avoids the incongruence of supreme paternalism to the deference of individual rights. Respect for independence is a central rule of any clinical moral and therefore, self-rule as a solution is not allowing patients to settle on their own choices. It is therefore pertinent for the doctors to make conducive conditions for the patients to make independent decisions. In a clinical situation, people come to a specialist asking for directions in settling on decisions since they do not have essential foundation or data for settling on educated decision. Probably, the most widely recognized and troublesome moral issues to explore emerge, when the patient’s self-governing choice clashes with the doctor’s helpful obligation to pay special mind to the patient’s best advantages. For whatever length of time, that the patient meets the criteria for settling on an independent decision, then the doctor ought to regard the patient’s choices even while attempting to persuade the patient generally. In Montgomery v. Lanarkshire Health Board (2015),[3] the Supreme Court of United Kingdom, after an exhaustive review of post Sidaway cases, disagreed, regarding the decision about information to be provided to a patient by his/her doctor to be left ultimately to the doctor’s clinical judgement. If we compare the hippocratic oath which emphasise “knowledge as is mine” and “benefit of the sick” to that of Charak’s discourse as “a physician who fails to enter the body of the patient with the lamp of knowledge and understanding can never treat diseases,” we can concur that from the standpoint of ethics enshrined in Indian Medical Texts, that the patient autonomy, is as respectful as medical paternalism. Informed consent is not just a formality but acts as an ethical as well as a legal safeguard in case of a medical malpractice suit. Once Informed consent in detail has been obtained, it establishes the fact that the accompaniments and that the patient had accepted the outcome of the result. This also establishes that the doctor respected the patient right to decide a key moral ethical and legal requirement (as established by the Supreme Court of India in the matter of Samira Kohli vs. Prabha Manchanda).[4] In case of an inadvertent complication, a well-documented and explanatory informed consent obviates any cause for negligence. It establishes that the patient knew the potential risks and had accepted voluntarily the result thereof.