1. Current Legal and Ethical Controversies in American Health Care
Informed Consent and Shared Decision Making

2. Instructors Marshall B. Kapp, J.D. M.P.H. Gregory Todd, J.D., M.D.
Associate Professor, College of Medicine
Program Director, FSU Internal Medicine Residency Program

3. Why Informed Consent and Shared Decision Making?
Autonomy/Self-Determination
Beneficence

4. Elements of Informed Consent
Voluntary
Competent decision maker
Informed

5. What Information Do You Want?
Nature of the problem
Recommended plan
Prognosis, with or without intervention
Reasonable alternatives (always including doing nothing)
Risks of recommended plan and alternatives
Patient’s responsibilities and limitations
Financial considerations?
Other?

6. Consent Forms Purpose/Effect
Document that the process of communication took place
Protect the health care provider
Does not take the place of proper communication.
Does create a presumption that proper communication took place, shifts burden to patient to prove that communication process was inadequate.

7. Case Discussions Mr. B, 75-year old man in generally good health
Should physician recommend PSA screening? Should the patient consent?

8. Ms. A, 45-year old woman in good health, no family history of breast cancer
Should physician recommend a screening mammography? Should the patient consent?

9. Ms. C is a 60-year-old, post-menopausal woman with no serious health problems and no significant family history of cardiovascular problems.
Should her physician recommend hormone replacement therapy?
Should Ms. C consent?

10. Shared Decision Making