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 …