The Origins of Informed Consent: Cancer Patients/Doctors

Columbia University Health Sciences, New York NY

Investigators

Abstract

DESCRIPTION (provided by applicant): The aim of this project is to revisit the introduction of informed consent into clinical practice in the 1970s. Most scholars have drawn a sharp line, arguing that a model of patient autonomy replaced medical paternalism during this decade. This research will address a gap in the literature on informed consent, examining how patients responded to the growing calls that they play a more active role in making treatment decisions. The hypothesis of this project is that the transformation from paternalism to autonomy has been exaggerated. Rather, patients responded to the advice of feminists and other health activists by forging a clinical encounter based on concepts such as negotiation, guidance, respect and trust. This new type of dialogue drew on the social and cultural setting in which patients and physicians interacted. The proposed project will employ methodology widely used by historians, including a review of the secondary literature and the development of explanatory theories based on primary data. The centerpiece of this research will be the examination of a unique collection of correspondence between breast cancer patients and America's leading patient advocate in the 1970s, Rose Kushner. By emphasizing the response of patients to the introduction of a consent-based model, this project will accomplish two related objectives: achieving a more complete historical understanding of informed consent and providing an alternative framework for modern patients and practitioners confronting challenging clinical decisions.