Intended for healthcare professionals

Observations Ethics Man

Informed consent is more than a patient’s signature

BMJ 2009; 339 doi: (Published 27 August 2009) Cite this as: BMJ 2009;339:b3224
  1. Daniel K Sokol, lecturer in medical ethics and law, St George’s, University of London
  1. daniel.sokol{at}

    Obtaining consent should be an ethical duty first and foremost, one central to respecting the autonomy and dignity of patients

    The phone call came at an inopportune moment: the Friday lunchtime curry at the local Sri Lankan restaurant, usually an oasis of delectable peace away from the hustle and bustle of the medical school. “I’ve had a dreadful consent experience” were the opening words, “dreadful.” The caller was a friend needing surgery to remove a submandibular gland.

    And so, as my curry lost its warmth, he proceeded to tell me about the strong pressure to tick the boxes on the consent form (“Oh, just tick them all—he’s a very good surgeon,” said the senior house officer (SHO)); about the SHO’s evident ignorance of the procedure; about his distinct sense of being a nuisance (“It’s half past six, and we usually go home at five o’clock,” the SHO observed); and about his general unease at the whole experience. He ended his account by saying that he had, under stress, signed the consent form but that on reflection he had not truly given consent. After our discussion he cancelled the operation …

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