Informed and Voluntary Decision Making
EngenderHealth is a pioneer in improving the quality of health care. One fundamental component of quality is ensuring that individuals are making informed decisions about services that directly impact their health. In the case of family planning, this includes making choices about whether they wish to have children, the number of children to have, and the spacing (number of years) between each pregnancy.
In an effort to advance informed decision making and ensure that family planning programs are voluntary and protect and fulfill women’s rights, EngenderHealth is taking a lead role in outlining steps needed to integrate human rights into family planning programming. With the goal of upholding a woman-centered and rights-focused approach, EngenderHealth’s work strives to operationalize human rights at the policy, service delivery, and community levels.
Informed choice is a voluntary, well-considered decision that an individual makes on the basis of options, information, and understanding. The decision-making process should result in a voluntary and informed decision by the individual about whether he or she wishes to obtain health services and, if so, what method or procedure the individual will choose and consent to receive.
Informed consent results from communication between a client and provider confirming that the client has made an informed and voluntary choice to use or receive a medical method or procedure. Informed consent can only be obtained after the client has been given full information about the nature of the medical procedure, its associated risks and benefits, and other alternatives. Consent cannot be obtained by means of inducement, force, fraud, deceit, duress, bias, or other forms of coercion or misrepresentation.
EngenderHealth publishes a number of technical training and educational materials about counseling, informed choice, and informed consent, including publications on family planning and the special counseling and consent needs of sterilization clients.
Health care providers are often required by law or institutional policies to obtain informed consent before administering certain medical procedures, including experimental methods or procedures. Although informed consent is often equated with a signed written form used to document an individual's decision, written consent is neither inherently necessary nor sufficient. Regardless of the presence or absence of written documentation, informed consent requires providers to ensure that a client receiving a method or treatment has knowingly and voluntarily agreed to be treated. Whether informed consent is written or verbal, however, it cannot replace the informed choice process, which is dependent on counseling and the information exchange between providers and clients.
Informed and voluntary client consent is especially important before a medical procedure that has a permanent or long-acting effect or that requires the skills of a trained provider. In family planning, voluntary sterilization is unique, in that it involves a surgical procedure to end fertility permanently. Therefore, many providers and funding agencies that support sterilization services specify the elements for informed consent and require written documentation of the client's consent. Although the purpose of informed consent should be to ensure the client's right to make a voluntary and informed decision, written consent is often required to provide evidence of provider compliance with informed consent requirements and to reinforce the importance of this client right.
EngenderHealth publishes a number of materials on counseling, informed choice, and informed consent, including publications on family planning and the special counseling and consent needs of sterilization clients.