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Editor - Alderson and Goodey1 present an important article
considering the different theoretical perspectives on the very practical
issue of consent. A recent study conducted by a multidisciplinary team at
The Queen's Medical Centre, Nottingham supports their assertion that
consent is understood in different and sometimes conflicting ways by
medical staff.
A questionnaire asked PrHOs, SHOs and nurses from various specialties
about training received in obtaining consent, training required and issues
of importance regarding consent. The questionnaire included vignettes or
case studies where respondents stated what action they would take when
faced with certain consent situations, for example a confused elderly man
requiring surgery. The questions relating to the case study aimed to
determine respondents' knowledge of legal issues involved in obtaining
consent, for example the age at which a person can consent to treatment,
which elements constitute valid consent and responses to patients who were
confused or refused treatment.
The findings suggest that doctors and nurses understand consent using
differing theoretical models. Doctors in this study often stated that the
major problem encountered when obtaining consent from patients was their
own lack of knowledge and experience of specific procedures and the risks
involved. They highlighted this area as a training need. Most doctors saw
consent from a functionalist perspective, as a one-sided delivery of
information. Very few doctors commented on communication issues, which
would involve a more critical theory approach where information is a two-
way exchange between doctor and patients. This approach was more favoured
by the nurses in the sample.
When asked in case study questions about patients refusing proposed
treatments, many doctors suggested sectioning under the Mental Health Act
(1983), although given the context of the scenarios this action would
often constitute a misappropriation of the Act. This supports the view of
Alderson and Goodey that 'functionalist consent is a polite ceremony, a
token of respect that is hardly necessary because benign, expert doctors
contribute to the smooth functioning of society; refusal and non-
compliance are irrational.'
We agree with Alderson and Goodey that consent is too complex to be
explained by any one theoretical model, although the results from our
study confirm that the majority of doctors have a functionalist approach
to consent issues. We intend to use the survey to implement a training
programme which, in addition to meeting the training needs expressed by
the respondents, also allows them to consider different and conflicting
ways of approaching the theoretical as well as the practical issues
involved in obtaining informed consent from patients.
Eleanor Peters, Research Associate
Maggie Challis, Senior Lecturer
Centre for Postgraduate and Continuing Medical Education
Queen's Medical Centre
Nottingham
1 Alderson, P. and Goodey, C. Theories of consent. BMJ 1998; 317:
1313 - 1315 (7 November)
Competing interests:
No competing interests
19 November 1998
Eleanor Peters
Research Associate
Centre for Postgraduate and Continuing Medical Education, Queen's Medical Centre
Informed Consent: Theory and Practice
Editor - Alderson and Goodey1 present an important article
considering the different theoretical perspectives on the very practical
issue of consent. A recent study conducted by a multidisciplinary team at
The Queen's Medical Centre, Nottingham supports their assertion that
consent is understood in different and sometimes conflicting ways by
medical staff.
A questionnaire asked PrHOs, SHOs and nurses from various specialties
about training received in obtaining consent, training required and issues
of importance regarding consent. The questionnaire included vignettes or
case studies where respondents stated what action they would take when
faced with certain consent situations, for example a confused elderly man
requiring surgery. The questions relating to the case study aimed to
determine respondents' knowledge of legal issues involved in obtaining
consent, for example the age at which a person can consent to treatment,
which elements constitute valid consent and responses to patients who were
confused or refused treatment.
The findings suggest that doctors and nurses understand consent using
differing theoretical models. Doctors in this study often stated that the
major problem encountered when obtaining consent from patients was their
own lack of knowledge and experience of specific procedures and the risks
involved. They highlighted this area as a training need. Most doctors saw
consent from a functionalist perspective, as a one-sided delivery of
information. Very few doctors commented on communication issues, which
would involve a more critical theory approach where information is a two-
way exchange between doctor and patients. This approach was more favoured
by the nurses in the sample.
When asked in case study questions about patients refusing proposed
treatments, many doctors suggested sectioning under the Mental Health Act
(1983), although given the context of the scenarios this action would
often constitute a misappropriation of the Act. This supports the view of
Alderson and Goodey that 'functionalist consent is a polite ceremony, a
token of respect that is hardly necessary because benign, expert doctors
contribute to the smooth functioning of society; refusal and non-
compliance are irrational.'
We agree with Alderson and Goodey that consent is too complex to be
explained by any one theoretical model, although the results from our
study confirm that the majority of doctors have a functionalist approach
to consent issues. We intend to use the survey to implement a training
programme which, in addition to meeting the training needs expressed by
the respondents, also allows them to consider different and conflicting
ways of approaching the theoretical as well as the practical issues
involved in obtaining informed consent from patients.
Eleanor Peters, Research Associate
Maggie Challis, Senior Lecturer
Centre for Postgraduate and Continuing Medical Education
Queen's Medical Centre
Nottingham
1 Alderson, P. and Goodey, C. Theories of consent. BMJ 1998; 317:
1313 - 1315 (7 November)
Competing interests: No competing interests