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Informed Consent: When Does the Patient Have a Right to Know? -- An Editorial

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The doctor-patient relationship is the basis for the formation of contemporary medical ethics. It involves the patient’s relinquishing control in favor of the physician’s experience and expertise and trust is an implicit part of this relationship.

The phrase, “in the best interest of the patient,” is one often heard within the medical community as well as the public sector. But just who determines what is to be in the best interest of the patient? Certainly the physician has medical knowledge which the patient may not, but which certainly can and should be given to the patient as it relates to their own health. Based on this information alone, the physician may choose to make certain decisions regarding the patient’s care.

The patient however is not only a physical being but a psychosocial one as well. They have feelings, lives, perhaps families and children, a career. Decisions made solely on the basis of medical information alone without discussing the impact of such decision on all other aspects of the patient’s life would be negligent. Without all the facts, the patient cannot make a truly “informed” decision regarding their future.

Currently, most organizations providing guidelines regarding the screening of women for cervical cancer recommend against human papillomavirus (HPV) testing in those under the age of 30. The Food and Drug Administration (FDA) has only approved the HPV test as an adjunct to an abnormal Pap test in those over the age of 30 as well and insurance companies reimbursement policies are often closely tied to such recommendations.

But what about the transmission aspect? Doesn’t a woman have the right to know if she has a highly contagious and sexually transmitted infection? I have dealt first hand with women receiving an HPV diagnosis and having to inform partners who have never heard of it. In one case, a woman was beaten physically unconscious after informing her partner of her HPV diagnosis. The guilt which women often speak of regarding having infected someone else before they were diagnosed is significant and the responsibility for educating men about HPV should not fall on a woman’s shoulders because she has been the one diagnosed.

By putting off screening and potential diagnosis of HPV until a woman is over the age of 21, the only thing created is a more significant gap in the education of women and for those who advocate the later screening I must wonder, just who is going to educate these women?

The medical community needs to do a better job of treating the patient as a whole and not just as they relate to their physical conditions.


NCI. Cancer Advances in Focus. Cervical Cancer. Web August 22, 2011.

American Cancer Society. Healthy Living Information to Help You Stay Well. Cervical Cancer. Web August 22, 2011. http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer

FDA. FDA Approves Expanded Use of HPV Test. Web August 22, 2011.

Reviewed August 22, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith

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