Freedom of Choice Informed Consent

¶ … consent and affirming the clients freedom of choice. The importance of this topic in relation to the professional counseling arena will be revealed in this examination as the important qualities of the inclusion of this practice will be highlighted and discussed. Before concluding, this essay will also reveal a personal reaction to the information discovered in this exercise.

At the heart and soul of every counseling session, is the idea of trust. The one seeking help and guidance must trust the counselor administering the treatment. The American Counseling Association suggested that "the informed consent advises the client of the counselor's policies, state and federal laws, and client's rights. Informed consent document can take many forms, but certain information is crucial so the client can truly give his informed consent and the counselor can comply with state laws and code of ethics. This document protects the client and counselor."

In many instances this idea of discussing informed consent is very rudimentary and is hardly noticed. The simple act of signing a form usually constitutes such acts of informed consent within a counseling scenario. This suggests that informed consent is either very well understood, or not understood very much at all, as the details within the act of giving informed consent demonstrates the practice of the essence of ethical behavior by placing a shared responsibility of the counseling session on both parties. By consenting to the counselor's practiced, the patient is sharing their freedom of choice and allowing it to be controlled.

Problems With the Process

At the heart of the informed consent practices within counseling is the spirit of ethical and moral behavior intended to benefit the patient first. This is not always the case as informed consent often is based in ignorance and not willful choice. Ingelfinger (1972) pioneered investigations into this subject and found that education must accompany consent or it is not really consent at all. He wrote " when a man or woman agrees to act as an experimental subject, therefore, his or her consent is marked by neither adequate understanding nor total freedom of choice. informed consent should represent a covenantal bond between consenting man and consenting man [that] makes them... joint adventurers in medical care and progress. Clearly, to achieve motivations and attitudes of this lofty type, an educated and understanding, rather than merely informed, consent is necessary."

The idea that consent is therefore based on intellectual capability and not the freedom of choice creates and interesting dynamic in exploring the relationship between the two ideas. Choice appears to be a clear demonstration of the will of the person, based on the educational experiences of their life up to that point. The mere act of ignoring the details of a consent form demonstrates a willful choice of consent, based on the importance of other self-contained opinions, namely that the form is not important or relevant in the healing process.

Accepting Responsibility

It becomes clear that understanding this concept is more important for the counselor than the patient in many aspects. The mere fact that a person is seeking counseling suggests that they are deficient in achieving self -- reliance in one way or another. It appears that these problems need to be addressed at the professional level if they are to be applied in a practical and beneficial manner that helps both the patient and the counselor.

Schuck (1994) agreed with this analysis when he suggested that "providers should alter the way in which they characterize and communicate treatment (and nontreatment) risks to patients so that the information will be more meaningful, accurate, and useful. Specifically, I urge that physicians begin to describe risks in comparative terms so that patients can view these risks in light of other, more familiar ones that they face in daily life. Only then can they appraise these risks in a sophisticated, autonomy-enhancing way."

This viewpoint suggests that both freedom of choice and willful informed consent is different for everyone. While attempts to objectify this ideal in many ways including the legal system, it is truly an impossible task to create a unified standard to which all must follow. The human elements of counseling must be interjected within understanding freedom to consent to treatment. Reason, experience, and wisdom must all contribute to the art of counseling as well as the clinical skills that balance the approach.

This balancing act becomes most important when dealing with young people and children who have relatively little power to consent to anything without parental approval. In many cases children may in fact be cognitive of informed consent, but other problems may arise. Redding (1993) wrote " the mental health literature is filled with anecdotal, case study, and empirical data indicating that parents often act contrary to the best interests of their child in the area of mental health treatment." This further distorts any attempt to apply a clear cut standard to the ideas inherent within freedom of choice and informed consent, there is simply too much gray area.