The basis of informed consent for BMT patients

During recent decades the doctrine of informed consent has become a standar d part of medical care as an expression of patients' rights to self-determi nation. In situations when only one treatment alternative exists for a pote ntial cure, the extent of a patient's self-determination is constrained. Ou r hypothesis is that for patients considering a life-saving procedure such as bone marrow transplant (BMT), informed consent has little meaning as a b asis for their right to self-determination. A longitudinal study of BMT pat ients was undertaken with four self-administered questionnaires. Questions centered around expectations, knowledge, anxiety and factors contributing t o their decision to undergo treatment. Although the informed consent proces s made patients more knowledgeable about the treatment, their decision to c onsent was largely based on positive outcome expectations and on trust in t he physician. Informed consent relieved their anxieties and increased their hopes for survival. Our conclusion was that the greatest value of the info rmed consent process lay in meeting the patients' emotional rather than cog nitive needs. When their survival is at stake and BMT represents their only option, the patient's vulnerability puts a moral responsibility on the phy sician to respect the principle of beneficence while not sacrificing the pa tient's right to self-determination.