Informed consent: Is your patient competent to refuse treatment?

Debra A. Pinals, MD
Associate professor of psychiatry, Director of forensic education, Department of psychiatry, University of Massachusetts Medical School, Worcester, MA

Informed consent in clinical settings is designed to allow patients to make rational choices about their treatment before it begins. When a psychiatric patient declines a treatment you recommend, how can you balance the 2 ethical principles in medicine: beneficence toward the patient and respect for individual autonomy?

Some authors have raised concerns that informed consent in physician-patient interactions are at times an empty exercise undertaken solely to satisfy a legal expectation. If executed properly, however, informed consent can enhance the therapeutic alliance and help improve treatment adherence.

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