Informed consent as a legal standard should assure that patient autonomy never rests on professional opinion alone.
For people struggling with mental illness, psychiatric care can often be life-changing. Many treatments can have a profound positive effect on not only how a person feels but also their emotional regulation, relationships, work, and sense of self. However, for psychiatric care to be truly effective, informed consent must become a stronger standard practice.
Over the years, some clinicians have fallen back on uneven or even unethical behavior when diagnosing and prescribing for mental health conditions. Informed consent has sometimes become a subjective practice that depends on the individual clinician’s judgment and the policies each office chooses to follow. When informed consent is treated as a pliable clinical process rather than the legal right it is, patients can be left confused, uninformed, and even misdiagnosed.
Consent as a right
Patients often seek out psychiatric help because they want to gain a better understanding of their feelings and emotions, want to learn how to manage stress better, or have been experiencing some concerning symptoms. While the psychiatrist is considered the expert, their expertise should never overrule a patient’s bodily autonomy or agency. Informed consent establishes a baseline that both clarifies the patient’s rights and cannot bend to the whims of individual providers.
As a legal standard across healthcare, informed consent requires practitioners to, at a minimum, inform patients of their diagnosis or working diagnosis that supports the proposed treatment, the intended purpose of the treatment or medication, expected improvements, known risks and side effects, and alternatives to the proposed treatment. The patient also needs to be fully aware that they have the right to ask questions, decline the treatment, or seek a second opinion.
The AMA Code of Medical Ethics gives guidance on informed consent, but the process is largely left up to the clinician’s personal definition of “ethical.” Ethics guidance is important, but informed-consent obligations also arise from legal and professional standards, which can vary by jurisdiction and clinical context.
The power imbalance inherent in psychiatry
There is a known power imbalance between psychiatric clinicians and those they treat. Unfortunately, this dynamic can also create some barriers to true informed consent.
For instance, a patient could be in crisis, hospitalized, viewed as incapacitated, under intense family pressure, or afraid that any disagreement could be perceived as an “unwillingness” to receive treatment. Some people may also worry that refusing medication could lead to a snowball effect that may potentially impact their professional, personal, or family life.
However, capacity is decision-specific and should not be seen as all-or-nothing in mental health. A certain diagnosis, hospitalization, or the emotional intensity of a situation should not automatically cancel out a person’s ability or right to consent.
Legal parameters around informed consent are also intended to protect more vulnerable patients. If a situation involves immediate danger or obvious coercion, the legal standard of informed consent allows intervention, when necessary, to remain in the patient’s best interest.
For informed consent to remain meaningful as a legal standard in cases of suspected diminished capacity or in an emergency, it must always include clear evidence and documentation before any other steps are taken by the practitioner, such as overriding the patient’s refusal of treatment.
Consent that goes beyond paperwork
Too often in mental healthcare, a signature on a form is considered sufficient to constitute informed consent. However, a mere signature is legally insufficient for true informed consent. If a patient is sleep-deprived, in crisis, or adjusting to new medications or dosage amounts, they may sign the form without a second thought if they believe they have to. Although the legal standard of informed consent is already in place, it amounts only to documentation of a transaction between a patient and their care provider, not proof of the patient’s understanding.
Without a focus on the quality of the conversation between the treating physician and the patient, true informed consent remains lacking. When psychiatric clinicians prioritize patient-centered care, conversations around informed consent before anything is signed or prescribed are able to take place more naturally.
Better informed consent means better care
Arguing for stronger standards around informed consent highlights the value of treatment grounded in honesty, respect, and collaboration between psychiatrist and patient. When patients can more clearly understand their diagnosis, the risks and side effects of a treatment, and why the clinician is recommending a certain treatment, they can often make better decisions for themselves.
True informed consent helps build a relationship between patients and their doctors based on trust. When patients know they can trust the providers delivering their care, they will be far more likely to be open with their clinician if they have concerns after consenting to treatment.
Psychiatric patients may be dealing with mental illness rather than physical illness, but that does not mean that their rights should mean any less. Clinical judgment from experts still guides treatment in psychiatry, but when treatment affects a person’s bodily autonomy, liberty, and future, clinical judgment is no longer enough. Informed consent as a legal standard should assure that patient autonomy never rests on professional opinion alone.
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