Informed Consent

Federal health officials announced new measures Thursday to allow the use of experimental drugs and devices in certain emergency and life-threatening situations where patients cannot be fully informed of the risks and possible benefits. The policy is intended to ease the confusion and ethical concerns of medical personnel dealing with emergencies where patients may be unconscious or comatose, and where there is no one else available to provide informed consent.

State officials said Thursday they are investigating complaints that Camarillo State Hospital did not obtain proper consent from patients to do research using drugs to treat schizophrenia. John White, the executive secretary of the state's Health and Welfare Agency Committee for the Protection of Human Subjects, which is leading the review, said the complaints center on allegations that consent forms failed to include descriptions of alternative-treatment drugs.

Surgeon General nominee Henry W. Foster Jr.'s 1976 medical journal article that acknowledges he performed hysterectomies on severely mentally retarded patients also warns against "injudicious and indiscriminate" use of the surgery and urges "informed consent" for patients, a relatively new medical doctrine at the time.

As President Clinton's ambitious health reform plan died a slow death in Congress, a long-slumbering giant awakened across the country: the health care consumer. Employers were preparing "report cards" to better compare the cost and quality of health insurers. State agencies were demanding information from hospitals about surgical outcomes. And individual consumers were asking more questions of their doctors and health plans.

The voices simply would not stop. In the end, Greg Aller was forced to listen. Following the commands of an unseen master, he says, he walked out to the highway, stuck out his thumb and started hitchhiking to the nation's capital to assassinate the President. Aller, a schizophrenic, never made it to the White House that day in 1989.

A modified toilet plunger developed at the University of California may work significantly better than conventional CPR to resuscitate heart attack victims, according to results of a trial reported today in the Journal of the American Medical Assn. The device was developed by UC physicians who treated a man whose son had used a toilet plunger to resuscitate him. It is essentially a suction cup that expands the lungs when it is pulled away from the chest.

Each week the ads pop up in the help-wanted sections of newspapers around this hub for medical research: "Reap the Rewards of Research." "New Year's Cash Flow Low?" "Earn Up to $150." The ads seek paid volunteers for medical studies, be it a closer look at toenail fungus or how the elderly sleep. Elsewhere, subjects come from the ranks of the sick; their payment is the hope of a cure for their illness.

UCLA psychiatrists were reprimanded by the National Institutes of Health on Wednesday for what the agency said was their failure to get proper informed consent from patients enrolled in an ongoing clinical trial of a new anti-schizophrenia drug. As part of the trial, many of the patients were taken off the drug to determine whether treatment was no longer necessary and, in the process, 23 of the 50 were reported to have suffered severe relapses, including hallucinations and paranoia.

The nation's Roman Catholic bishops urged the Supreme Court today to refuse to give constitutional status to the "right to die." In papers filed with the justices in the first right-to-die case the court has agreed to hear, the bishops said lower court decisions on several "informed consent" issues have "confused recent social emphasis on absolute personal autonomy with the goal of informed consent, obliquely choosing to ignore the full import of the doctrine."