People’s Pharmacy | The informed consent charade: an ethical failure?

Every health care intervention is supposed to begin with “informed consent.” What does that mean? The health care provider has a legal and ethical responsibility to make sure the patient has adequate information to make a knowledgeable decision. Patients should have a clear understanding of both the risks and benefits before agreeing to proceed.

No patient should be expected to undergo surgery without knowing what is involved and the possible consequences, especially the risks. We think this should apply to medications as well as to surgery.

Unfortunately, obtaining informed consent is often treated as a pesky bureaucratic hoop to be hurdled rather than an opportunity to ensure that the patient really has considered all the possible consequences of surgery. Sometimes, signing the legalistic form is the last thing a patient does before being wheeled off to the operating room.

Few of us feel confident enough to actually read the document carefully and ask questions about it once we are dressed in a flimsy hospital gown and have an IV in our arm. We may not even be wearing our glasses. Perhaps we’ve already been given a medication to help calm us, which could also affect our decision-making. And there is often an implied rush–if the patient lingers over the paperwork, they may feel that they are holding up the surgery.

What’s buried in that paperwork? Hopefully, the surgeon already told you about the major risks of surgery before the day of the procedure, but perhaps not everything. You may be signing permission for another person, such as a resident, to do the surgery rather than the surgeon you met beforehand.

The form may not include any information about alternatives you might choose, types of anesthesia for example. It almost assuredly will not offer insight on what happens if you refuse. Who is likely to do that?

Clearly, when obtaining informed consent is treated as a bureaucratic box to be checked, the patient is not really being protected. This applies to medications as well. Whether the drug comes as a pill, an injection or a topical patch, the prescriber should describe the anticipated benefits as well as the potential side effects. The patient should learn which are common and which are serious enough to merit a call to the doctor or a visit to the emergency department.

You may wonder why drug companies list so many scary side effects in their commercials on TV. Partly, it is because the FDA requires them to inform people about risks. On the other hand, disclosing the risks also helps protect the manufacturers from legal action. If you know about the possible problems and decide to go ahead and take the medicine, then that’s on you.

One reader told of experiencing consequences he had not anticipated. “My doctor prescribed finasteride for an enlarged prostate. Six months later, my penis has shrunk dramatically and I can’t get an erection. It is impossible to achieve an orgasm. Men need to be warned!”

Health care professionals have a moral responsibility to discuss all adverse reactions, including those that may be embarrassing. The Hippocratic oath is broadly understood to forbid doctors from doing harm. But nearly all treatments carry some risk, and patients deserve to know what they are before agreeing to be treated.

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Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of this newspaper or e-mail them via their Web site: www.PeoplesPharmacy.com.

This story was originally published April 24, 2026 at 1:00 AM with the headline "People’s Pharmacy | The informed consent charade: an ethical failure?."