6 - More Barriers to Good Communication

Summary

Health care policy experts in the United States have been studying for years how to improve the experience of dying and how to avoid overutilization of inappropriate and unwanted medical interventions at the end of life, but progress toward these goals is slow. In fact, the problems described in preceding chapters appear to be getting worse in some respects. As Chapter 3 explained, the law of informed consent is relevant to these problems but doesn’t do much to solve them. Informed consent law and the underlying ethical principles of autonomy and beneficence impose a duty to inform patients of the risks and benefits of treatment such as late-stage chemotherapy and life-sustaining care (including the risk of harms and the likelihood of success measured by cure, extended life expectancy, or palliation of symptoms). But the mechanical process of legal consent rarely helps improve patient understanding of the complexity and magnitude of the decisions she faces.