Beyond informed consent: did cancer patients challenge their physicians in the post-World War II era?

Historians have debated the degree to which past patients have provided meaningful consent prior to medical interventions. This article, a chart review of 170 patients treated for cancer between 1945 and 1970, adds to this literature by exploring the years when informed consent was being introduced in medical practice. As would be expected in a largely paternalistic era, physicians controlled most of the clinical encounters, even concealing cancer diagnoses. Yet thirty-one (18 percent) of the patients showed some involvement in decision making, either writing restrictions on their consent forms, asking probing questions, or otherwise challenging physicians' orders. Although the overall number of patients studied was small, minority and other ward patients were as likely as white, private patients to speak up. This study concludes that most patients passively assented to treatment, signing consent forms without making any inquiries. But a small group of patients challenged their physicians, leading them to learn more about proposed treatment options and perhaps make more informed decisions. Although motivated in part by the increasing attention to better consent practices, these patients spoke up for other reasons as well, possibly including their basic personalities, prior negative experiences in hospitals, or apprehensiveness regarding specific types of interventions. Further research should explore the factors--beyond the introduction of informed consent--that have historically promoted better dialogue between physicians and patients.