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The process of obtaining informed consent is fundamental to the practice of modern medicine. Within the realm of cosmetic surgery and elective procedures, the ability to openly and effectively discuss risk and benefit is particularly crucial for building patient rapport and optimizing outcome. Patients who are well informed make more knowledgeable decisions, formulate more realistic expectations, and often enjoy greater satisfaction. When treating ethnic skin, the physician should recognize the physiologic differences in skin with darker pigmentation and discuss the anticipated response to cosmetic and laser procedures. In this setting, varying cultural models also need to be taken into consideration in order to ensure comprehensive patient understanding and full informed consent.
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GOALS OF INFORMED CONSENT
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The process of consultation and obtaining informed consent offers the opportunity to create a relationship whereby the patient learns to trust that the physician with offer the most appropriate therapy to the best of his or her ability. The physician should then also be confident that this trust is based on the provision of the most accurate and best available evidence. In cosmetic dermatology, the provider is faced with the additional complexity of variable individual expectations and frequent misinformation. Prior to consultation, the patient may have already been influenced by erroneous or misleading information acquired from numerous nonprofessional sources, including other lay persons as well as media and press focused on consumer-directed advertising. Additional goals of the informed consent process therefore also include patient education and identification of potential concerns and problems.1 Solid clinical acumen, expert technical skill, and the best intentions often cannot substitute for good rapport, generated by an open preoperative discussion with the patient. Finally, the cosmetic dermatologist must also accept that he or she has heightened ethical obligations in the setting of performing elective, life-enhancing interventions, rather than medically necessary or life-saving procedures.2
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ELEMENTS OF INFORMED CONSENT
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Informed consent is a fundamental principle of modern medicine, a well-recognized ethical obligation of health care providers. The foundation of informed consent was formulated in 1914 by New York Justice Benjamin N. Cardozo, who stated: “Every human being of adult years and sound mind has a right to determine what shall be done with his body, and a surgeon who performs an operation without the patient's consent commits an assault for which he is liable in damages.”3 The term informed consent was coined in case law in 1957 and published in A Patient's Bill of Rights in 1972 by the American Hospital Association.
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The concept of informed consent states that not only is it required that patients give permission for a particular treatment but also the permission must be based on a demonstrated understanding of the nature, consequences, and alternatives of the proposed intervention. Patients are entitled to a discussion of the specific risks, benefits, options, and alternatives of a procedure, including the ...