Enforcing Patient Preferences

Abstract

The legal and ethical doctrine of informed consent is well accepted in modern medicine. Nonetheless, medical interventions sometimes take place in the absence of informed consent, particularly in the case of life-sustaining medical procedures. These procedures ordinarily are reimbursed by third-party payers. This article proposes as a strategy to ensure greater attention to patient preferences in medical decision making that financial reimbursement for each medical service be linked to a requirement of valid patient (or surrogate) consent to the service involved. Utilization review bodies could monitor informed consent in the same way that other aspects of necessity, appropriateness, and quality are now monitored.To insure that medical interventions take place after informed consent, Kapp proposes that reimbursement for care be linked directly to proof that the treatment was consented to by either the patient or a suitable designated decision maker. If proof of informed consent is absent, compensation should be denied to the health care provider. Informed consent standards could be monitored by utilization review bodies.