Enforcing Informed Consent Requirements: Form or Substance?

In his article "Enforcing Patient Preferences: Linking Payment for Medical Care to Informed Consent," in this issue of The Journal,¹ Kapp argues that many medical interventions currently are being imposed on patients in the absence of voluntary, competent, and informed consent. He proposes that utilization review organizations link financial reimbursement for medical services to "a requirement of valid patient (or surrogate) consent."¹ The proposal by Kapp is that individual and institutional health care providers will not be paid for a medical service unless a signed consent form covering that service is found in the patient's chart.

There are difficulties in Kapp's formulation of the problem, and many more with his formulation of the solution. With regard to the problem, although empirical research is limited, there is indeed evidence of a gap between the rhetoric of informed consent and the frequency with which physicians involve patients in medical decisions