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Realizing Informed Consent in Times of Controversy: Lessons from the SUPPORT Study

Published online by Cambridge University Press:  01 January 2021

Abstract

This Essay examines the elegantly simple idea that consent to medical treatment or participation in human research must be “informed” to be valid. It does so by using as a case study the controversial clinical research trial known as the Surfactant, Positive Pressure, and Oxygenation Randomized Trial (“SUPPORT”). The Essay begins by charting, through case law and the adoption of the common rule, the evolution of duties to secure fully informed consent in both research and treatment. The Essay then utilizes the SUPPORT study, which sought to pinpoint the level of saturated oxygen that should be provided to extremely low birth weight infants to demonstrate modern complexities and shortcomings of the duty to secure informed consent. This Essay shows how the duty is measured by foreseeability of risks and benefits in human research and why federal regulators believed the tradeoffs in risk and benefits from differing oxygen levels administered in the support study were foreseeable. It then explores the contours of the duty to secure informed consent when applied to researchers who also serve as treating physicians, highlighting how common law duties differ in jurisdictions that apply the professional standard and those that apply the patient-centered material risk standard. This Essay provides new insight into what the law must do to make real the notion that [e]very human being of adult years and sound mind has a right to determine what shall be done with his body.”

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2016

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References

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Oxygen saturation is a measurement of the level of oxygen in the blood. Target oxygen saturation rates for physicians treating adult patients is typically somewhere between 88 and 98 percent. Patients with low oxygen saturation levels are treated with “inspired oxygen” (FiO2)—that is, air with a higher concentration of oxygen then that found in the atmosphere. See, e.g., Driscoll, B. R. et. al., “BTS Guideline For Emergency Oxygen Use in Adult Patients,” British Thoracic Society, available at <https://www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/emergency-oxygen-use-in-adult-patients-guideline/appendix-1-summary-of-recommendations-emergency-oxygen-use-in-adult-patients-guideline/> (last visited July 6, 2016). This essay shorthands oxygen saturation as oxygen throughout.+(last+visited+July+6,+2016).+This+essay+shorthands+oxygen+saturation+as+oxygen+throughout.>Google Scholar
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Schloendorff v. Soc'y of N.Y. Hosp., 105 N.E. 92, 93 (N.Y. 1914).Google Scholar
See, e.g., Transcript, supra note 8.Google Scholar
Id., at 120–21 (quoting a parent of Dagen Pratt).Google Scholar