Informed Consent In Psychology: What It Is, Parts And Functions
People cannot receive psychotherapy without explicitly giving consent. Therapies are not harmless: they have their advantages and disadvantages, and without a doubt they change people’s lives.
Informed consent in psychology It is the process by which information is provided to the patient so that he or she can freely decide on any diagnostic and therapeutic intervention in their contact with the psychologist.
This tool is essential to begin any type of psychological intervention, and requires that a series of characteristics be met that we will discover below.
Informed consent in psychology can be understood as the process in which information is provided, both orally and in writing, to the patient about the treatment they want to receive. This way you can freely decide whether or not you want to start therapy, being aware of its potential benefits and also the risks that the treatment may entail.
The origins of this consent are in put the principle of autonomy above that of charity. The principle of autonomy is the ethical principle that recognizes the patient’s ability to give himself norms or rules without influence from other people, while the principle of beneficence is the obligation of the professional to act for the benefit of the client. The principle of autonomy is one of the most important requirements in the performance of professional practice.
After informed consent has been given, the patient, In your free, voluntary and conscious consent, you can decide or not to accept psychotherapy. This decision will be taken into account as something binding to the extent that the patient shows full use of his or her faculties after receiving this information, being aware that the decision to accept or reject the therapy will bring a series of benefits and, also, disadvantages.
Historical background
It may be surprising, but the moral recognition that the patient has the right to be informed about the therapy he or she is going to receive and that he or she is the one who can decide, ultimately, to start and end the therapy, is something recent. Today this right is supported by multiple judicial decisions and lacks deep historical roots. It is recognized more for legal aspects than for therapeutic ones.
Since the time of Hippocrates, the patient-therapist relationship was unequal, and was regulated by the paternalistic principle of beneficence: always seeking the good of the patient, regardless of their consent. Likewise, there were many cases in which this principle was ignored due to the desire for knowledge, and sometimes the good of the patient was not a priority either, but rather the expansion of knowledge even if it caused harm.
We have one of the most important historical antecedents for the development of informed consent in psychology in the decision taken by the Ministry of Health of the German Reich in 1931, in which it issued a regulation on medical therapies and experiments with humans. In that opinion the right of the patient to give consent to participate in clinical trials was recognized. It was, therefore, a great advance in the recognition of patients’ rights.
But ironically it was in that same country where, with the rise of Nazism and the start of World War II, this recognition would be ignored. Human experimentation became fashionable among the bloodthirsty Nazi doctors, who tried all kinds of non-consensual experiments on Jews, gypsies, homosexuals and political prisoners. There was a lot of suffering caused with the intention of expanding science in the German context.
After the defeat of Nazi Germany at the end of the conflict, the Nuremberg trials were held. The court of that city established the basic principles in human experimentation , thus creating the Nuremberg code. This code has been updated in subsequent revisions, giving rise to ethical standards for human experimentation, also extrapolated to the field of clinical therapies.
Currently, the therapist and patient relationship has become horizontal, that is, it has become equal. This does not mean that the relationship between therapist and patient is the same. , since the doctor, the psychiatrist and, of course, the psychologist are the educated professionals who can guide the therapy with their knowledge, while it is the patient who receives the treatment and decides whether he wants it or not. Be that as it may, the paternalistic principle that governed therapies for a long time has been overcome.
What information should be exposed?
Three informative elements must be presented in the informed consent. which will determine the objectives of the communication that will be transferred by written or oral means.
Among the information necessary for the patient to understand the health service that will be offered, we have:
Who receives this consent?
Informed consent must be expressed in the form of a written or oral document. Such a document is signed by the patient in case he accepts the terms of psychotherapy. If it is oral, the patient must say explicitly and clearly that he does agree to start the therapy, with a recording of this.
Informed consent arises from the right to be able to decide whether or not to receive therapy, that is, it implies making a personal and self-determined decision. It is the patient and not a family member, partner or friend who must give permission for therapy to begin.
The person who must receive the information is the patient, although people linked to him or her may also be informed for different reasons and to the extent that the patient allows it to be so. If the patient has any type of disability, they will also be informed, in a manner appropriate to their understanding capabilities. and also informing the person who is your legal representative.
Informed consent by proxy
Although informed consent in psychology is directly addressed to the patient, sometimes he or she is not the one who consents to receiving the therapy.
Due to different reasons, the patient may not have sufficient capacity to decide for himself, and other people decide for him. This is called informed consent by proxy, which It occurs when the subject does not have sufficient capacity for self-determination to know what is best for them. This happens in the following situations:
1. Under 12 years old
In children under 12 years of age, their opinion should be heard, especially if they are close to that age. At a minimum, their opinion and desire to start therapy should be taken into account, to see any possible reluctance that the minor may have regarding the treatment. Your consent will not be binding, but you still have the right to know what you are going to receive.
2. Minors between 12 and 16 years old
If the patient is between 12 and 16 years old, it is important to study his or her ability to make a deeply considered decision. At these ages the individual could be mature enough to be able to decide in a more or less adult manner, but each case must be studied professionally. If you are over 16 years old, you can accept his consent.
3. Conflictive situations
If the child or adolescent is in a conflictive situation, such as having divorced parents, both parents must be kept informed and the consent of both must be ensured. Unless there is judicial authorization or one of the parents has custody, consent must be given explicitly by both parents.
4. Exception
There is a special situation in which, although the minor cannot decide on the intervention, therapy can be started even if the parents have rejected it. This can be agreed like this when the professional considers that the parents’ rejection is harmful to the minor and as long as the authorities have been consulted and there is legal protection, the psychologist can start therapy.
Benefits of informed consent in the context of psychotherapy
There are many benefits of informed consent in psychology, both for the patient who is going to receive psychotherapy and for the psychologist who is going to apply it. Among these benefits we can highlight:
1. Protection
By explicitly informing the patient of what is going to be done during therapy, the clinician is protected, since This informed consent is proof that the psychologist has told the patient what he was going to do. If there has been something that was in the consent but that the patient did not like, since he was aware of it, he should not be able to complain.
In the same way, this consent protects the patient by communicating their rights and obligations during therapy, in order to be able to complain if the professional has not fulfilled their role. The psychologist may make a mistake or even act negligently, which gives the patient the right to initiate relevant legal proceedings.
2. Access to information
This consent allows the consultant access to validated, coherent and specific information for your situation, in addition to allowing you to understand what the path that psychotherapy is going to follow and what it hopes to treat during its course.
3. Better quality of the intervention
Informed relationship and joint therapist-patient decision making allows for greater engagement. By understanding the meaning of the actions that the psychologist is going to carry out, the patient can have a more or less clear idea of ​​what she is going to receive during the treatment.
4. Promotes clinical research
Informed consent in psychology promotes clinical research in two ways. One is that in psychotherapy it can be explained to the patient that his data can be used for treatment research, accepting or not whether he is comfortable with it. If yes, Your specific case can be used to improve treatments and help more people like him or her.
The other way is directly with laboratory research. In psychology, as in other sciences, laboratory experiments require voluntary participants who agree to undergo such an experiment. Before starting, they are given a document that specifies what they are going to do, in addition to being able to decide to leave the experiment at any time. This type of consent protects the researchers and gives security to the participant.
Criticisms about its use
Although there is no doubt that informed consent is a necessary tool in not only clinical and experimental psychology, but also in other disciplines such as medicine, There are many people who consider this document to be something that offers several disadvantages.
It should be said that many people who think this way continue to have a traditional and paternalistic approach to how therapy should be applied, which is very anachronistic for current times. Among these arguments we have:
How to automate the management of informed consent in psychotherapy?
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