When the patient delivers a low-birth-weight infant that requires extensive time in the neonatal intensive, should she be held responsible? Where do we draw the line? More importantly, on what basis do we draw the line?
An older generation was far more likely to understand itself and its social world in terms of sin and virtue, vice and godliness. Lack of self-control and weakness of will were moral failings to be avoided. That sort of language has fallen on hard times.
Using the patient’s worldview to challenge his or her decision and establish a treatment plan—implying the view is shared by the physician when it is not—could be seen as manipulative and deceptive.
The growing number of web-savvy patients alters the power dynamic in the patient-physician relationship. In the older model of care, physicians served as unchallenged experts who alone devised therapeutic plans for patients.
People have a social obligation to conform to the general rules of sleeping: sleep at night, in a bed, in a private place away from public view, and in proper attire.
Physicians make patients aware of those interventions that they (the patients) may then refuse. In short, informed consent is less about patient decisions than it is about restraining physicians.