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Notes -
How would you go about protecting the patients from themselves? In the examples you mentioned, doctors have a duty to explain things and even repeat doing so when necessary, but you can't force them to act the way you want.
With side effects the issue is that from the most typical medicine anyone takes, to ones with more serious side effects, you will find a long list of potentially dangerous side effects. So long that is ignored. People are trained by such experience to dismiss the issue.
I agree with another poster that the key medical advice should be written down. People forget things and if they have it written down a greater share will follow it. Good communication requires adequate emphasis and summarization. People are fallible and then a decent share of people would be lower IQ. Of course, the doctor's should do their job and at the end of the day the patient has their own responsibility to live their life and to follow their doctor's advice. You can't do it for them.
The doctor's duty is to try to be effective communicators that adequately explain the issue in a manner that most people would understand and able to follow, if the patient's desire to do so. It isn't a checklist that just mentioning an issue means that they have done a good job.
This essentially means some paternalism, since it requires extra effort for some patients. But only to a point. Basically any field will have a million of "reasonable person" subjective tests that good professionals must try to follow.
Only allowing elective work to be done (especially risky or life altering stuff) after a longitudinal period sounds like a good step. Pretty common to do this for trans stuff but less so for things like a tummy tuck or the sterilization, which can also go wrong but we are happy to do.
I generally get the feeling the consent process exists to protect us from patients not the other way around, and longer/more clear communication may not help with that.
Written communication can be a problem sometimes though - you are going to have to write down that one of the risks is death, or other scary things and it's going to be worth it, and rare. But having that on a piece of paper that someone can stare at can be a bad thing.
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