Canadian Association of Gastroenterology Practice Guideline for informed consent--gastrointestinal endoscopy.

Informed consent has undergone a transformation from an ethical concept to a legal doctrine. It is based on the ethical principles of self-determination and autonomy. Over the past several years, courts have established physician liability based on the failure to obtain adequate informed consent. It is the duty of all gastrointestinal endoscopists to obtain legally adequate informed consent before performing any endoscopic procedure. The Canadian Medical Protective Association publication Consent: A Guide for Canadian Physicians outlines how consent is viewed in the Canadian jurisdiction. The standard consent form on the last page of the brochure is advised, and a specific consent form for endoscopy is not recommended. The principles of informed consent apply to any intervention and are not unique to gastrointestinal endoscopy. A signed consent form has undoubted evidential value, but is often simply an administrative step that does not allow physicians to review adequately the information that patients need to base their decisions for or against treatment. Background information in the form of information sheets, brochures and similar materials are useful adjuncts to the consent process, but should be provided well in advance of signing the consent form. Courts have made it clear that except in urgent and pressing circumstances, patients must be given adequate opportunity to consider the implications of what they are consenting to. Regardless of what supplementary methods are employed to provide patients with information before consent, it must be emphasized that they can only supplement and not replace dialogue with the patient. For evidential purposes, a contemporaneous note should be made confirming that the supplementary material was provided and that after reviewing it the patient was given an opportunity to ask questions about it before consenting. In Canada, the courts rely heavily on progress notes if it is clear that they were made contemporaneously with the events they recorded. When consent explanations are given it is recommended that the doctor note briefly some of the significant points raised in conversation with the patient. Such notations, particularly if they identify questions or special concerns expressed by the patient, can validate the consent process better than any other documentation. If the note on the office or hospital chart records something relevant to the discussion with the patient, it will serve as much more credible evidence than the recollection of any of the parties involved in a lawsuit.