Obtaining informed consent is the formal component of shared decision making by the physician and patient. Unfortunately, the documents developed by institutions to formally record the process of obtaining consent are often substituted for the process itself. Informed consent embodies certain conditions that must be satisfied; these include adequate information, freedom from coercion, and sufficient decision-making capacity. The patient’s lifestyle, the likely functional outcome of each choice, and psychosocial factors will affect what the patient needs to know.

The physician should ensure that the patient can comprehend information well enough to make important life choices. Facts about the patient’s medical condition and available interventions, including their risks and benefits, should be explained to and understood by the patient. Not all minor or rare risks or benefits need to be articulated, but those that could be expected to affect a particular patient’s choice need to be explained. Limiting or forgoing treatment and the consequential risks and benefits ordinarily should be discussed.
Certain attributes of informed consent are especially important with the older patient. The physician must ensure that the patient is not coerced—for instance, by the family or physician imposing goals and values—and that the patient does not acquiesce because of a desire to please others or a perceived loss of self-determination and independence (as may occur with institutionalized or profoundly dependent home-care patients). The process of obtaining informed consent from an older person may require more time because of sensory deficits or slowed cognition.