BIOETHICS FOR CLINICIAN .4. VOLUNTARINESS

In the context of consent, ''voluntariness'' refers to a patient's rig ht to make health care choices free of any undue influence. However, a patient's freedom to make choices can be compromised by internal fact ors such as pain and by external factors such as force, coercion and m anipulation. In exceptional circumstances - for example, involuntary a dmission to hospital - patients may be denied their freedom of choice; in such circumstances the least restrictive means possible of managin g the patient should always be preferred. Clinicians can minimize the impact of controlling factors on patients' decisions by promoting awar eness of available choices, inviting questions and ensuring that decis ions are based on an adequate, unbiased disclosure of the relevant inf ormation.