Informed consent as a framework for treatment: Ethical and therapeutic considerations

Significant changes in the nature of doctor-patient relationships have required more patient involvement in decision making and, as much as possible, fully informed consent. This is necessary, particularly, where a treatment can be hazardous, where it may have both positive and negative effects, or where one treatment is not clearly superior to another. These conditions are fequently met in the use of family therapy. To establish conditions of trust early in the therapeutic process, it is necessary to openly discuss with the family members the various competing 'best interests' of the different members, and try to anticipate potential psychotherapeutic hazards posed for various members during the therapy. Open acknowledgement and discussion of these competing 'best interests' not only establishes trust, but also can deflect some patients' resistance to therapy and paradoxically, strengthen their commitment to the therapeutic work. Three cases of the successful use of 'informed consent as a treatment strategy' are described.