Informed consent: don’t throw out the moral baby with the critical bath water

It is well over two decades since Ian Kennedy published “Unmasking Medicine” based on his Reith lectures.1 He launched an inspired attack on medical paternalism in the UK which in many important respects has now been won—at least in principle. Clinical practice is now expected to embody the duty both to protect life and health and to respect individual autonomy—the right of competent patients to make informed choices about their medical options. Indeed, it is now both legally and professionally clear that, when these two duties are in conflict, the latter trumps the former. Ultimately, the competent adult patient has the final say about whether or not to accept or reject proposed treatment, even when refusing may mean death.

There is now a well articulated body of statute and case law designed to reinforce the right of patients to consent to or refuse treatment on the basis of appropriate information. Guidance from the GMC and professional organisations—particularly the BMA—does the same.2,3 The Department of Health has issued specific instruction about the standard of obtaining consent to which Trusts are expected to conform, including the structure and content of consent forms.4 In relation to medical education, courses abound in ethics and law applied to health care that emphasise the moral and legal importance of obtaining consent to a reasonable standard. Similarly, courses in communication skills are now offered to engender in young doctors the abilities required to meet this standard. …