Informed consent is an unavoidably complicated issue

News p 955 Education and debate pp 1000–1011 Letters p 1022 Personal views pp 1026-1027

The issue of informed consent within medical practice, research, and publication is coming increasingly to the fore as the balance of power in the doctor-patient relationship tips towards patients. Last week Britain's General Medical Council heard a case in which a paediatric cardiologist was accused of going beyond the consent that he was given to treat a child. The child died, and he was found guilty of serious professional misconduct and erased from the medical register for six months (p 955).1 When, last year, we published a cluster of articles asking whether we should decline to publish studies where patients had not given fully informed consent we prompted a flood of correspondence. We received over 50 letters, most of them argued with unusual care and clarity. Authors split down the middle between those who argued that we should always insist on informed consent (except in very limited circumstances) and those who thought that there were occasions when we need not. Today we try to advance the debate by publishing further responses to last year's debate, including some from patients' representatives. Within the broad context of informed consent we also explore the particular issue of consent for publication of material that emerges from the doctor-patient relationship.