Intended for healthcare professionals

Rapid response to:

Education And Debate

Informed consent: lessons from Australia

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7328.39 (Published 05 January 2002) Cite this as: BMJ 2002;324:39

Rapid Response:

Knowledgeable consent and responsibilities

The paper on consent by Skene and Smallwood clearly reflects the
ascendant and currently dominant position of the ethical principle of
(patient) autonomy, the right to self-determination, over the previously
held superior ethical principle of (medical) beneficence which could be
loosely interpreted on occasions as paternalism. Such changes in position
of these ethical principles have a significant consequence of how
patients, healthcare professionals and lawyers interact. There is a
consequence of such a change in position. One cannot have control of a
decision and associated power, yet abrogate the responsibility when things
do not occur as hoped, planned or perceived.

Decision making (the legal capacity test) sits at the heart of
consent. English law presumes that all adults have capacity. If the
patient has been provided with quality information in an appropriate style
befitting the patient then they can offer a decision based on that
knowledge - "knowledgeable consent". However, when exercising their
autonomy, patients and their advocates must accept the responsibilities
that go with these decisions. Such responsibilities include the
consequences of that decision, which may include events that transpire,
and are against the hopes of the patient, so-called adverse events. Those
who advocate for patients, and patients themselves, need to be aware that
the use of autonomy as a leading ethical principle carries these heavy
responsibilities. Patients, their advocates and the courts cannot have it
both ways; with appropriate information concerning consent (knowledgeable
consent) the patient's decision, and any consequences flowing from that
decision, must include responsibility for that decision. Consequent events
are not necessarily the responsibility, or fault of, healthcare
professionals or healthcare unless clinical negligence has occurred.

Competing interests: No competing interests

08 January 2002
Jeffrey C McILwain
Consultant, Clinical Risk Management
Whiston Hospital, Prescot, Merseyside L35 5DR