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In light of the modern ethical ethos, psychoanalysts will have to respond to increasing pressure on health professionals to tell their clients about alternatives to treatment the professional is offering. Outlining alternative treatments for the patient's symptoms and diagnosis is one aspect of the contemporary view of what constitutes informed consent. It has been only in the second half of the twentieth century, says O'Neill, that there has been a
shift from reliance on the doctor's judgment about what is best for the patient to belief in the patient's right to self-determination. The traditional doctrine, known as therapeutic privilege—which holds that the healer may withhold information that would be harmful to the patient—was decisively undermined by the medical abuses of the Nazis. The Helsinki Declaration drafted by the World Medical Association in 1964, and later revised several times, requires that potential subjects “must be adequately informed of the aims, methods, anticipated benefits, and potential hazards of the study [or treatment]. They must be told that they are free not to participate and free to withdraw at any time” (p. 14). This declaration has had enormous impact on current ethical and legal views of informed consent. For example, the following definition proposed by a team of Canadian ethicists is a direct descendent:
In the context of patient consent, “disclosure” refers to the provision of relevant information by the clinician and its comprehension by the patient. Both elements are necessary for valid consent. Disclosure should inform the patient adequately about the treatment and its expected effects, relevant alternative options and their benefits and risks, and the consequences of declining or delaying treatment. The clinician's goal is to disclose information that a reasonable person in the patient's position would need in order to make an informed decision. (Etchells etal., 1996, p.387)
How is a psychoanalyst to comply with this new eth