Which of the following shifts the determination of informational needs from the physician to the patient

Which of the following shifts the determination of informational needs from the physician to the patient?

• A- The professional practice standard of disclosure.
• B- The reasonable person (material risk) standard of disclosure.
• C- Professional codes of ethics.
• D- “ The thing speaks for itself "doctrine.

The answer that most likely shifts the determination of informational needs from the physician to the patient is: D. "The thing speaks for itself" doctrine.

Here's why:

- The professional practice standard of disclosure:

This standard requires physicians to disclose information that a reasonable physician in similar circumstances would disclose. It doesn't necessarily shift the determination to the patient, as the physician still makes the judgment based on their professional knowledge and experience.

- The reasonable person (material risk) standard of disclosure:

This standard requires physicians to disclose information that a reasonable person in the patient's position would want to know, considering the materiality of the risk. While this considers the patient's perspective, the physician ultimately decides the materiality of the risk and therefore still plays a significant role in determining informational needs.

- Professional codes of ethics:

These codes generally emphasize the physician's responsibility to provide patients with clear and complete information. They don't explicitly shift the determination to the patient but rather support informed consent and patient autonomy.

- "The thing speaks for itself" doctrine:

This doctrine applies when the nature of the risk or harm is so obvious that it doesn't require any explanation from the physician. In this case, the patient's own understanding of the situation is assumed to be sufficient, potentially shifting the determination of informational needs to the patient.

Therefore, although none of the options fully shift the determination from the physician to the patient, the "thing speaks for itself" doctrine comes closest to doing so by assuming the patient already understands the information based on the obvious nature of the risk.

It's important to note that even with this doctrine, physicians always retain the ethical and legal responsibility to disclose information that could reasonably affect the patient's decision-making. Open communication and patient-centered care should remain paramount regardless of the doctrine.