The Fallacy of Absolute Transparency: Why Complete Disclosure Isn’t Always Beneficial in Healthcare Consent

Dr. Deep Satiar,

General Surgery resident, Amritsar

In the realm of healthcare, the concept of consent holds paramount importance. It serves as the cornerstone of patient autonomy, ensuring individuals have the right to make informed decisions about their treatment. However, the notion that complete transparency, disclosing every detail and potential complication, is always necessary or even beneficial, is a fallacy that warrants critical examination.

Firstly, it’s essential to recognize that the value of consent lies not solely in the exhaustive disclosure of risks and complications, but rather in fostering a trusting and collaborative relationship between healthcare providers and patients. While transparency is crucial, inundating patients and their families with an exhaustive list of potential complications can be overwhelming and counterproductive. It can instill unnecessary fear, anxiety, and decisional paralysis, detracting from the patient’s ability to make a truly informed choice. Healthcare professionals undergo extensive training and utilize their expertise to assess and communicate risks based on individual patient factors, medical evidence, and professional judgment. However, presenting every theoretical complication, regardless of its likelihood or relevance to the patient’s specific case, is neither practical nor conducive to shared decision-making.

In many instances, providing exhaustive lists of complications may not align with the principles of beneficence and non-maleficence. The principle of beneficence dictates that healthcare providers should act in the best interest of their patients, which may entail focusing on pertinent risks rather than overwhelming them with improbable scenarios. Likewise, the principle of non-maleficence emphasizes the obligation to avoid causing harm, including psychological distress, which excessive disclosure of remote complications may inadvertently inflict. I would like to share an instance from my own personal experience. A patient once presented with hollow viscus perforation and required immediate exploratory laparotomy. We asked for proper consent for the entire said procedure including ileostomy as well. And after being explained the entire procedure, the patient’s family refused to get the procedure done after knowing the post-operative management and complications of ileostomy and a day later, the patient presented with pre-renal AKI and sepsis due to the delay in operative procedure, even after intra-abdominal drain placement.

Furthermore, the assumption that complete transparency equates to patient autonomy overlooks the nuanced nature of decision-making processes. Patient autonomy encompasses more than merely being aware of every conceivable risk; it involves understanding the relevant information, weighing alternatives, and making decisions consistent with personal values and preferences. By tailoring information disclosure to the individual patient’s needs and cognitive capacity, healthcare providers respect autonomy without sacrificing the quality of decision-making.

Moreover, the emphasis on complete transparency may inadvertently undermine trust in healthcare providers’ expertise and judgment. Patients seek guidance from healthcare professionals not only for information but also for interpretation and guidance based on their clinical experience and knowledge. Excessive focus on risks may overshadow the confidence and reassurance that patients derive from their providers’ expertise, leading to unnecessary doubts and second-guessing.

Let’s talk about something really interesting from neurosurgery, where we always take the consent for “DEATH-ON-TABLE”. Even procedures like decompression craniotomy, which are mostly life-saving, can be life-threatening in some cases like- old aged patients as a result of geriatric comorbidities. Knowing about the consequences such as death-on-table can lead to refusal for the procedure by the patient attendants, however, such consent is a mandatory part of our healthcare system.

Another type of consent is blanket consent, especially in an ICU setting, where we don’t explain everything but we take consent as whole before beginning with the treatment, involving various emergency procedures like- intubation, central line placement or life-saving drug administration etc. This helps us to save time while treating the patient in case of any emergency.  However, such consent is legally inadequate.

In conclusion, while transparency and informed consent are indispensable components of ethical healthcare practice, the insistence on complete disclosure of every potential complication is neither practical nor conducive to optimal patient care. Instead, healthcare providers should strive to achieve a balanced approach that prioritizes relevant information tailored to individual patient needs, fosters trust and collaboration, and upholds the principles of beneficence, non-maleficence, and patient autonomy. By doing so, we can ensure that the consent process serves its intended purpose of empowering patients to make informed decisions while promoting their overall well-being and trust in the healthcare system.

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