Managed care and (Un)informed consent

One of the most important moral achievements of contemporary American health care is the institutionalization of informed consent. Despite its paternalistic past, American medicine in the 1960s began to embrace the right of all patients to accept or reject medical treatments. Patients were offered choices on the basis of increasingly comprehensive disclosures of treatment options and their attendant risks, including the option of no treatment at all. Informed consent was grounded in autonomy, itself an expression of respect for human dignity. The rapid spread of managed care arrangements through the 1990s has jeopardized this achievement. Because of its financial incentives, managed care threatens to reverse the achievements of informed consent. For a number of reasons related to the very nature of rehabilitation, the threat to informed consent in this arena is greater yet. If the benefits of a professional and cultural consensus on informed consent are to be sustained for another generation, active steps will have to be taken to protect it in the managed care environment.