Legal norms vs. doctors and patients’ perceptions of the content and meaning of the informed consent to medical intervеntion

Abstract

Informed consent to medical intervention represents the principle of individual autonomy, recognized in Russian law and medical practice nearly 30 years ago, but it is still viewed as controversial and even rejected. The purpose of informed consent is to provide obligatory prior notification about the consequences and risks of a medical procedure to be performed, as well as other possible options of treatment. Based on the results of anthropological and legal studies, the article focuses on issues concerning obtaining informed consent and its interpretations, comparing the meanings attributed to the document by lawyers, government agencies, courts, as well as doctors and patients. The legal nature of the consent consists in expressing a person’s will for medical intervention and his decision which cannot be made by anyone else. The meaning that patients and doctors attribute to informed consent, as shown by results of a survey and interviews, is shifting risks and responsibility for negative consequences from the medical organization to the patient. Stylistic features of the document influence its perception by ordinary citizens, resulting in fear and doubts about the doctor’s qualifications. Russian courts usually follow a formal approach when judging whether the signature reflects the patient’s real expressed will. Failure to understand the meaning of the document being signed, a circumstance that is sometimes cited when justifying an error in a transaction, is usually not recognized as sufficient. Although the document is formulated on behalf of the patient, he receives a ready-made text, containing information of a professional nature. This causes difficulties in the patient’s understanding of the document that has been drawn up on his behalf. However, when a person argues that he signed an informed consent without understanding its content, courts often do not consider his words sufficient, thus failing to stimulate medical organizations to provide a document that is catered to ordinary people’s medical and linguistic competences.