Original ArticlesHow Changes in Health Care Practices, Systems, and Research Challenge the Practice of Informed ConsentKarlawish, Jason H. T. MD*; Fox, Ellen MD†‡; Pearlman, Robert MD, MPH†§ Author Information *From the Department of Medicine, Division of Geriatric Medicine, University of Pennsylvania, Alzheimer’s Disease Center, and Center for Bioethics, Philadelphia, Pennsylvania. †From the National Center for Ethics, Veterans Health Administration, White River Junction, VT. ‡From George Washington University, Washington, DC. §From the VA Puget Sound Health Care System and Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington. The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs. University of Pennsylvania Health System, Department of Medicine, Division of Geriatric Medicine, Ralston-Penn Center, 3615 Chestnut Street, Philadelphia, PA 19104-2676. E-mail: [email protected] Medical Care 40(9):p V-12-V-19, September 2002. Buy Abstract Informed consent has been the central model for ethical decision making in clinical care and research. The goal of informed consent is to protect the right of a competent person to make his or her own health care decisions based on personal values and goals. But changes in health care practices, systems, and research have challenged this well-established goal. This paper examines these changes to show that decisions about care and research directed to individual patients rely more and more upon a population perspective. As a result, efforts to promote patient choice should attend to the ethical decision-making processes of institutions that create and sustain this perspective. © 2002 Lippincott Williams & Wilkins, Inc.