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January 16, 1987

A History and Theory of Informed Consent

Author Affiliations

The Hastings Center Hastings-on-Hudson, NY

The Hastings Center Hastings-on-Hudson, NY

JAMA. 1987;257(3):386-387. doi:10.1001/jama.1987.03390030116032

Not too long ago I witnessed an incident in a large teaching hospital in which consent to perform an amputation was secured from a patient in a particularly disturbing manner. A senior attending physician had been trying for a few days to persuade an older patient suffering from diabetes to give permission for a below-the-knee amputation of his gangrenous left leg. While taking a group of residents on rounds he mentioned that he had had an especially hard time obtaining permission for an operation that he believed was absolutely essential to save the patient's life. He pointed to one of the residents and said "part of the job of being a physician is to deal with problems like this—get the damn consent."

The young resident trotted off to find the reluctant patient. About 20 minutes later he emerged triumphant from the patient's room waving a signed consent form for all