A fundamental problem of consent

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Abstract
A consultant anaesthetist gave a diclofenac suppository for postoperative pain to a patient having four teeth extracted under general anaesthesia in the dental surgery. He did not seek the patient's specific consent preoperatively for use of the suppository but told her afterwards what he had done. Charged before the professional conduct committee of the General Medical Council with failure to obtain informed consent and assault, the anaesthetist was found guilty of serious professional misconduct and admonished. This decision has far reaching implications and has caused great concern. Consent and a patient's right to self determination are at the root of many important problems in medical ethics. In recent years consent, or the lack of it, has also become an increasingly common issue in medical negligence litigation. By contrast, the failure by a doctor to obtain consent to bona fide treatment has rarely if ever been the sole foundation for a finding of serious professional misconduct. I report a case recently brought before the professional conduct committee of the General Medical Council in which such a decision was reached. The facts of the case were simple. A 22 year old woman attended her local dental surgery for extraction of two wisdom teeth (lower eights) and two other teeth (lower fours). She knew that she was to have a general anaesthetic and gave her consent both verbally and by implication. She signed a form which stated: “I would like the dentist named overleaf to examine me under the NHS and to give me every necessary care and treatment which I am willing to undergo within NHS arrangements.” Not unusually, there was no consent form specifically for the anaesthetic. Though the Poswillo report recommended that a national general anaesthetic consent form should be devised for general dental practitioners,1 none has been produced. …

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