Making consent patient centred

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Background Several UK organisations have published guidance on improving procedures for consent in the past few years (box 1). Despite this, the BMA's working party on consent stated that “current awareness of the relevant ethical and legal principles relating to consent among the medical profession is largely inadequate.”3 Although other initiatives have sought to improve guidance, the working party emphasised the need to improve implementation of what was already recommended as best practice. The BMA's view, that patients would benefit if more clinicians were familiar with guidance on consent, may be right. However, our experience suggests that even full compliance with current guidance may not prevent unnecessary procedures in some patients.6 Box 2 gives an example of one of the many patients at the National Refractory Angina Centre who conclude that coronary intervention is not necessary once they are given an opportunity to define their objectives and the risks are put in context. In this patient's case, only his first angioplasty was consistent with his objectives as it improved his chances of survival. The other procedures were aimed at relieving symptoms and may be associated with an increased risk of death.7 Consent for procedures (such as angiography) must be founded on the patient's objectivesCredit: ANTONIA REEVE/SPL Box 1: Recent developments in guidance on consent practice 1998: GMC encourages clinicians to find out about patients' individual needs and priorities when deciding what information to disclose about interventions.1 2000: NHS Plan calls for change of culture in consent practice “to recognise the central importance of the rights of each patient”4 2001: Report of the Bristol Royal Infirmary inquiry calls on clinicians to acknowledge patients as partners with different but equal expertise5 2001: BMA consent working party emphasises consent as a process that gives patients the opportunity to express concerns about treatment3 2002: New model consent policy and consent forms implemented, incorporating check list to ensure clinicians disclose appropriate information when seeking patients' consent Footnotes Contributors and sources Contributors and sources: MRC and AL founded the National Refractory Angina Centre in 1998 to provide an innovative chronic angina service focused on patient defined objectives. CH has collaborated with MRC and AL for the past six years, both as a member of the clinical team and in the centre's programme of research into the management of chronic refractory angina. JB is a graduate in philosophy and theology and in health care ethics, with experience in pain research. He has worked with MRC and AL for the past two years to develop the centre's patient centred philosophy of care and to articulate the wider ethical implications of this approach. Competing interests None declared.