Reconsidering the Process of Informed Consent in Assisted Reproductive Technology: Experiences and Implications for Practice
Reflections
Fabiola Fedele, Barbara Cordella, Viviana Langher
Psychological Studies, 28 March 2020
Abstract
A patient’s conscious decision to voluntarily undergo a therapeutic treatment is called informed consent (IC). The aim of IC is to provide information about health and treatment options and increase patient’s participation in healthcare decision-making. IC therefore honors the ethical principles of human autonomy and self-determination. In the field of assisted reproductive technology (ART), the process of communication and mutual understanding between patient and doctor (the IC process) is a current and relevant issue due to its medical, ethical and psychological implications. This exploratory research aims to understand how couples with infertility problems relate to the ART IC, and it proposes the innovative experience of IC conversations with a psychologist. It also provides practical advice on a better use of IC process in ART centers.

Systematic Review of Preoperative Risk Discussion in Practice
Original Reports
Davis M. Aasen, Brett M. Wiesen, Abhinav B. Singh, Christi Piper, Ben Harnke, Allan V. Prochazka, Aaron S. Fink, Karl E. Hammermeister, Robert A. Meguid
Journal of Surgical Education, 16 March 2020
Abstract
Background
Informed consent is an ethical imperative of surgical practice. This requires effective communication of procedural risks to patients and is learned during residency. No systematic review has yet examined current risk disclosure. This systematic review aims to use existing published information to assess preoperative provision of risk information by surgeons.
Methods
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a guide, a standardized search in Ovid MEDLINE, Embase, CINHAL, and PubMed was performed. Three reviewers performed the study screening, with 2-reviewer consensus required at each stage. Studies containing objective information concerning preoperative risk provision in adult surgical patients were selected for inclusion. Studies exclusively addressing interventions for pediatric patients or trauma were excluded, as were studies addressing risks of anesthesia.
Results
The initial search returned 12,988 papers after deduplication, 33 of which met inclusion criteria. These studies primarily evaluated consent through surveys of providers, record reviews and consent recordings. The most ubiquitous finding of all study types was high levels of intra-surgeon variation in what risk information is provided to patients preoperatively. Studies recording consents found the lowest rates of risk disclosure. Studies using multiple forms of investigation corroborated this, finding disparity between verbally provided information vs chart documentation.
Conclusions
The wide variance in what information is provided to patients preoperatively inhibits the realization of the ethical and practical components of informed consent. The findings of this review indicate that significant opportunities exist for practice improvement. Future development of surgical communication tools and techniques should emphasize standardizing what risks are shared with patients.

Attitudes About Informed Consent: An Exploratory Qualitative Analysis of UK Psychotherapy Trainees
Original Research Article
Charlotte R. Blease, Tim Arnott, John M. Kelley, Gillian Proctor, Tobias Kube, Jens Gaab, Cosima Locher
Frontiers in Psychiatry, 13 March 2020
Open Access
Abstract
Background
Ethical informed consent to psychotherapy has recently been the subject of in-depth analysis among healthcare ethicists.
Objective
This study aimed to explore counseling and psychotherapy students’ views and understanding about informed consent to psychological treatments.
Methods
Two focus groups were conducted with a total of 10 students enrolled in a Masters course in counseling and psychotherapy at a British university. Questions concerned participants’ understanding of informed consent including judgments about client capacity; the kinds of information that should be disclosed; how consent might be obtained; and their experiences of informed consent, both as a client and as a therapist. Focus groups were audio-recorded, transcribed, and analyzed using qualitative content analysis. Coding was conducted independently by three authors.
Results
Comments were classified into three main themes: (1) the reasons and justifications for informed consent; (2) informed consent processes; and (3) the hidden ethics curriculum. Some trainees expressed significant doubts about the importance of informed consent. However, participants also identified the need to establish the clients’ voluntariness and their right to be informed about confidentiality issues. In general, the format and processes pertaining to informed consent raised considerable questions and uncertainties. Participants were unsure about rules surrounding client capacity; expressed misgivings about describing treatment techniques; and strikingly, most trainees were skeptical about the clinical relevance of the evidence-base in psychotherapy. Finally, trainees’ experiences as clients within obligatory psychotherapy sessions were suggestive of a “hidden ethics curriculum”—referring to the unintended transmission of norms and practices within training that undermine the explicit guidance expressed in formal professional ethics codes. Some students felt coerced into therapy, and some reported not undergoing informed consent processes. Reflecting on work placements, trainees expressed mixed views, with some unclear about who was responsible for informed consent.
Conclusions
This qualitative study presents timely information on psychotherapy students’ views about informed consent to psychotherapy. Major gaps in students’ ethical, conceptual, and procedural knowledge were identified, and comments suggested the influence of a hidden curriculum in shaping norms of practice.
Implications
This exploratory study raises important questions about the preparedness of psychotherapy students to fulfill their ethical obligations.

On shared decision-making and informed consent
Editorial
James L. Bernat, Michael P. McQuillen
Neurology Clinical Practice, 11 March 2020
Excerpt
In the idealized concept of shared decision-making, the physician and patient comprise a collaborative clinical decision-making dyad. The physician contributes medical knowledge, training, experience, and judgment, whereas the patient contributes personal values and health care goals through which to evaluate how each treatment option could fulfill those goals. As partners, the patient and physician collaboratively achieve a mutually agreeable medical decision through an ongoing communication process that creates informed consent…

Informed Consent in Fetal Hypoplastic Left Heart Syndrome [BOOK CHAPTER]
Constantine Mavroudis, Angira Patel, Rupali Gandhi
Bioethical Controversies in Pediatric Cardiology and Cardiac Surgery
Springer, 29 February 2020; pp 163-177
Abstract
Informed Consent in the setting of complex fetal congenital heart disease such as hypoplastic left heart syndrome involves many concerned individuals who include: the mother, the father, the obstetrician, the pediatric cardiologist, the pediatric cardiac surgeon, and many others. It is the duty of the physician to administer and perform informed consent under high risk pre- and postnatal circumstances that require high risk surgical options without which the newborn baby would most certainly die. We explore the intricate roll that physicians play in the informed consent process from prenatal to post-natal circumstances which include making decisions about pregnancy termination, comfort care, and staged palliation. Important considerations such as the importance of the woman’s bodily integrity, autonomy, and the ethics of comfort care are discussed with reference to other complex congenital heart lesions. We conclude that informed consent for HLHS decisions is best practiced by a multi-disciplinary organized approach that will allow comprehensive counseling by multiple care-givers in a timely fashion. Ultimately, the obstetrician/pediatric cardiologist team continue to be the primary physicians that assist with shared decision-making.