INFORMED CONSENT

Informed consent generally has three elements: (1) providing the person with relevant information in a format they understand, (2) ensuring the decision is voluntary (free of coercion), and (3) ensuring the person has the capacity to consent (ACOG 2021, Beauchamp 1994). Providers should comply with their pertinent state laws (Sawicki 2011).

(1) Facilitate Understanding of Information

• Use plain language, the teach back method, visual aids when possible, and avoid jargon to support understanding.
• Spend time explaining concepts, checking understanding, and answering questions.
• A second appointment may be needed to help a person understand or decide.
• Use appropriate, qualified interpretation services in the person’s primary language
• Grant requested accommodations to ensure understanding and effective communication, including facilitating supported decision-making (see below).
• Consider a person-centered approach for consent to trainee involvement in counseling and abortion care (see Chapter 11).
• If State-Mandated Counseling is legally required, and includes scientifically inaccurate information, inform the patient of factual discrepancies.

(2) Ensure Decision Is Voluntary

• A decision must be voluntary for informed consent. Unfortunately, reproductive coercion (RC) is common and may impede true informed consent.
• RC may include explicit or covert interference with contraceptive methods or attempts to control pregnancy outcomes. RC can come from intimate partners, family, community members, or clinicians. These actions limit a person’s autonomy.
• Disabled people are > 4 times more likely to experience RC than non-disabled people (Amos 2023). People of color are more likely to experience RC both from partners (Hill 2019, Muñoz 2023) and health care providers (Swan 2024).
• Screen for RC and IPV in private. Ask if anyone has tampered with or prevented contraceptive use or is pressuring them toward a particular pregnancy outcome and if they have trusted support people.

(3) Ensure Capacity to Consent

• Capacity to consent should be evaluated on an individual basis to avoid incorrect assumptions as to a person’s ability to make decisions. Capacity may relate to substance intoxication/withdrawal (see below), minor consent (see above), mental health disabilities, or intellectual and developmental disabilities (I/DD).
• For adults with I/DD, providers should presume capacity to make health care decisions, adapting as needed. Capacity to consent to health care is fluid and may change with context, topic, time, emotional or physical state, medication, support, or accommodations.
• Capacity should be assessed with the person’s preferred supports in place, such as:
  • interpretation services;
  • use of plain language;
  • supported decision-making (see below);
  • using breaks, repetition, and visual aids during an appointment; and any other reasonable accommodations or modifications that are requested.

Additional resources:

Equitable and accessible informed healthcare consent process for people with intellectual disability: a systematic literature review (Dunn 2023)