Informed consent--a contemporary myth?

In the absence of consent from the patient, in theory, every surgical procedure could be considered a criminal offence. Until recently, the patient's consent was considered to have been implicitly granted as long as he or she presented at the appointed date for an elective surgical procedure. This situation no longer prevails and a patient's consent now has to be explicitly and formally granted. In the event of subsequent litigation, the surgeon may be requested to provide evidence that the patient received thorough information on his or her pathology, on the treatment options, the reason the surgical intervention was decided upon, its potential outcome and possible complications. The surgeon may also be requested to provide evidence that the information was understandable to the patient, while being comprehensive and scientifically accurate, and that the patient was in a position to give informed consent. This requirement is based on the assumption that every adult has the intellectual capacity to comprehend and recall a large amount of technical information which was previously unknown to him or her and which, out of necessity , has been delivered in a short period of time during one or a limited number of consultations. There is no clear cut definition of what constitutes adequate information but it is commonly defined as what a reasonable person in the patient's situation would need to make an appropriate decision. This is inevitably subjective and, if contested, the decision as to whether a specific patient was in a position to give informed consent may eventually reside with a judge or a jury. They will need to see themselves as potential patients, and accept there may be a limit to their capacity to understand and memorise technical information. Although the legal literature accepts in theory that too much information may be counter-productive, such common sense understanding of patient information may no longer prevail when it comes to judging a specific case, particularly if a patient has suffered a rare complication and the surgeon is unable to prove that adequate warning had been given. Some technical aspects of risk may only become understandable to a layman when they are markedly simplified. All surgeons are aware when they embark on highly-complex explanations, that a number of patients get out of their depth and the only way to re-establish contact is to simplify the issues and stick to the essential points. Different patients have different …