Education And Debate

Making consent patient centred

BMJ 2003; 327 doi: (Published 13 November 2003) Cite this as: BMJ 2003;327:1159
  1. John Bridson (, acting director of studies, MSc in health care ethics1,
  2. Clare Hammond, specialist registrar in cardiology2,
  3. Austin Leach, consultant in anaesthesia and pain management2,
  4. Michael R Chester, director2
  1. 1Unit for the Study of Health Care Ethics, Department of Primary Care, University of Liverpool, Liverpool L69 3GB
  2. 2National Refractory Angina Centre, Cardiothoracic Centre, Liverpool NHS Trust, Liverpool L14 3PE
  1. Correspondence to: John Bridson
  • Accepted 28 August 2003

Taking the time to explore patients' objectives not only improves consent procedures but may avoid some interventions altogether

Guidance on obtaining patients' consent for treatment encourages doctors to consider their needs and priorities when disclosing information.1 However, the focus on disclosure, which has arisen from the need to tell patients about risk, has meant not enough attention is given to patients' objectives. To make consent properly patient centred, clinicians need to ask patients what they want from treatment before they discuss treatment strategies.2 We believe this approach is essential, especially in the management of chronic illness. It should also help protect reticent patients, whose objectives may differ from the assumptions made by clinicians.


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 …

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