A/HRC/18/37 D. Informed consent 61. Guaranteeing informed consent is a fundamental feature of respecting an individual’s autonomy, self-determination and human dignity. Informed consent invokes several human rights elements that are indivisible, interdependent and interrelated. In addition to the right to health, these include the right to autonomy, freedom from discrimination, freedom from non-consensual experimentation, security and dignity of the human person, recognition before the law, freedom of thought and expression and reproductive self-determination. Individual autonomy, bodily integrity and well-being are central to the right to health framework. This framework identifies the availability, accessibility, acceptability and quality of health information as key elements of that right, defined as “the right to seek, receive, and impart information and ideas concerning health issues” (E/C.12/2000/4, para. 12). In a report to the General Assembly, the Special Rapporteur defined informed consent as “a voluntary and sufficiently informed decision, protecting the right of the patient to be involved in medical decision-making, and assigning associated duties and obligations to health-care providers” (A/64/272, para. 9). 62. Health information needs to be of the highest quality, freely available on a nondiscriminatory basis, accessible to the individual’s particular communication needs (including special physical or cultural circumstances), and presented in a manner culturally and otherwise acceptable to the person consenting (ibid., para. 23). Informed consent requires that communication is cognizant of varying levels of comprehension and not be too technical, complex, hasty, or in a language, manner or context that the patient does not understand. This is particularly true and necessary for vulnerable populations, such as older persons, who may require additional attention, explanation, or assistance in receiving and adequately understanding the health information that is imparted by the caregiver to the patient prior to treatment. 63. Evaluations have consistently found a deficit in the information provided to older persons to help them make an informed decision, in particular those with less formal education.37 Some healthcare workers can be dismissive of the particular vulnerabilities of older persons, failing to adequately obtain informed consent because it may be more complex than usual to do so. A one-size-fits-all approach is often inappropriate with respect to older persons, A more customized, individualized, age-friendly approach is required to better address the needs of this group. This will imply moving beyond basic health literacy, which does not adequately secure the right to health, into greater health information awareness and education, possibly through peer networks. 64. In addition to the imbalance of power, experience and trust inherently present in the doctor-patient relationship, structural inequalities can result in the voluntary or informed nature of consent being significantly compromised (ibid., para. 45). With a view to protecting the rights of older persons, States should establish appropriate support mechanisms that would help overcome subsequent challenges to achieving informed consent, including community involvement and comprehensive counselling. 65. The role of health-care providers is crucial for ensuring informed consent. In many cases, there is a lack of training for health-care workers in communicating health information to older persons, who may have special needs that are often left unaddressed. Medical education and training institutions must incorporate education regarding informed consent for vulnerable populations and their particular needs into curricula. Structural 37 16 Sugarman et al., “Getting meaningful informed consent from older adults: a structured literature review of empirical research”, Journal of the American Geriatrics Society, vol. 46, No. 4 (April 1998)