7.7.3 Sufficient information
As clearly stated in Gillon's definition, the moral and legal requirement to acquire
consent commits the health care professional to providesufficientinformation to
allow that consent to be given, therefore the room for negotiation is sometimes
limited. In the conclusion to part A of this chapter Jean McHale points out that
recent developments might contribute towards a standardisation of approaches to
the disclosure of information [18]. However, there are contexts within which the
autonomous patient must be allowed to determine the amount of information they
are given. On the issue of prognosis, for example, a health care professional might
have good reason to assume that it is in the interests of the patient to know their
predicted future, but it would be difficult to justify imposing the information upon
an autonomous individual who has clearly stated that they do not wish to know
[19]. Thus the autonomy of the patient and the need to respect it might have to
trump the health care professional's commitment to fuller disclosure and their
own beliefs about what is in the patient's best interest. Just as Jean McHale requires
the nurse to justify withholding information, the nurse must also have valid rea-
sons for imparting information that the competent patient does not wish to receive
[20].
The term `adequate information' calls for judgement to be applied, and since at
least the early 1990s there has been a great deal of debate around the issue of what
counts as sufficient, with some commentators suggesting that the standards
required in some contexts force doctors to be needlessly cruel in imposing infor-
mation upon people [21]. One area of concern relates to clinical experimentation,
where we have come to believe that the information sufficient for consent must be
particularly detailed. As a research nurse will often be the person involved in the
process of providing information and acquiring consent, she must contribute to
the comple xdecisions about how much information is sufficient, and when more
information is unnecessary and maybe even harmful [22].
7.8 Deliberation
The requirement that a patient should have the time and opportunity to deliberate
before making a choice seems common sense. Health care choices often have far
reaching effects, some of which will only become apparent upon reflection. Even in
the most straightforward of decisions a patient will probably benefit from believing
that they had been given time to decide rather than being rushed into a decision.
Admittedly there will be emergency situations in which this will not be possible.
For example, if an event occurs within childbirth which threatens the safety of the
woman and the unborn child, a decision might have to be made with great haste.
Furthermore, the practicalities of outpatient clinics might determine that certain
choices need to be discussed and decided on in the course of one visit. However,
generally speaking, time should be allowed for the patient to absorb the infor-
mation given and think about the choice they might want to make. This could be
particularly true, for example, when someone is faced with choices soon after
receiving bad news. Many oncologists claim that once a patient has been given a
126 Nursing Law and Ethics