The Royal College of Surgeons seems to agree with me Re: Margaret McCartney: Cameras and complaints
I woke up this morning, to hear BBC Radio 4 telling me that the Royal College of Surgeons has just issued new guidance around consent. I am reading this guidance, so far with no serious disagreement with it, and I have reached its section 4.6 which starts with the crux of the matter:
'The Montgomery case has changed the focus of the consent process from one in which the surgeon would explain the procedure to the patient and obtain their consent to proceed, to one in which the surgeon sets out the treatment options and allows the patient to decide.'
Readers had already been told (in the Introduction) that 'The Montgomery case closed the gap between regulatory guidance and case law by shifting the focus of consent towards the specific needs of the patient'.
This is a source of complication which I did not initially appreciate when I became involved in debate about end-of-life behaviour: that clinicians pay a lot of attention to guidance, and guidance frequently does not seem to fit the law (the 'gap' the RCS mentions).
I do have a comment. My EoL issues, hinge on sorting out whether patients are self-determining with relation to refusals of treatments (notably, because it is the least complex to analyse, the situation of a patient [in his own home] who explains to a family carer 'I definitely do not want anyone to attempt CPR on me from now onwards', and who then arrests before he has also told his GP - my issues hinge on whether 999 paramedics should be told to 'trust the family carer' in such a situation, when the family carer is more up-to-date than 'the records'). It is far more difficult, to apply the principle of patient self-determination to many situations, and consent to surgery is one of those: the guidance is correct in my view [based on what I've read so far] but I think it will be very challenging in application. The RCS seems to understand that it will be challenging to apply the 'new' legal situation to surgery (I write 'new' because in my view the Mental Capacity Act enshrined the situation in English law about a decade ago - people 'just did not seem to notice' !).
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The Royal College of Surgeons seems to agree with me Re: Margaret McCartney: Cameras and complaints
I woke up this morning, to hear BBC Radio 4 telling me that the Royal College of Surgeons has just issued new guidance around consent. I am reading this guidance, so far with no serious disagreement with it, and I have reached its section 4.6 which starts with the crux of the matter:
'The Montgomery case has changed the focus of the consent process from one in which the surgeon would explain the procedure to the patient and obtain their consent to proceed, to one in which the surgeon sets out the treatment options and allows the patient to decide.'
Readers had already been told (in the Introduction) that 'The Montgomery case closed the gap between regulatory guidance and case law by shifting the focus of consent towards the specific needs of the patient'.
This is a source of complication which I did not initially appreciate when I became involved in debate about end-of-life behaviour: that clinicians pay a lot of attention to guidance, and guidance frequently does not seem to fit the law (the 'gap' the RCS mentions).
I do have a comment. My EoL issues, hinge on sorting out whether patients are self-determining with relation to refusals of treatments (notably, because it is the least complex to analyse, the situation of a patient [in his own home] who explains to a family carer 'I definitely do not want anyone to attempt CPR on me from now onwards', and who then arrests before he has also told his GP - my issues hinge on whether 999 paramedics should be told to 'trust the family carer' in such a situation, when the family carer is more up-to-date than 'the records'). It is far more difficult, to apply the principle of patient self-determination to many situations, and consent to surgery is one of those: the guidance is correct in my view [based on what I've read so far] but I think it will be very challenging in application. The RCS seems to understand that it will be challenging to apply the 'new' legal situation to surgery (I write 'new' because in my view the Mental Capacity Act enshrined the situation in English law about a decade ago - people 'just did not seem to notice' !).
Competing interests: No competing interests