More Transformation than Mutation I feel: 'paternalism' to 'genuine informed consent'.
In her response of 17 July, Julie Haesebaert uses the word mutation to describe the current shift away from 'doctor knows best' and a top-down hierarchical approach to healthcare, towards a more complex 'care model' with the patient's decisions assuming priority, and much greater dispersal of involvement in the patient's care, etc. I think 'mutation' carries with it an implication of change without planning - 'randomness' - and this change is I believe better described by the word transformation: it is not a 'random' change, and is at least in the UK being driven by recent court rulings which stress that society now expects clinicians to respect 'the individuality and autonomy of patients'.
Put simply, we should now be an era of genuine informed consent: an era in which clinicians offer treatments and inform patients about prognoses, and patients decide which offer(s) to accept. Running alongside that change from paternalism to autonomy, is an acceptance of a greater role for lay carers: in reality, the traditional distinction between healthcare professionals and family carers is logically [and I believe legally] unsupportable in many situations, as I have attempted to illustrate with my 'Anne, David and Dr Jones' scenario (refs 1 and 2).
This change is a challenge for policy creators, as I have recently pointed out (ref 3) - but while I much prefer [for England where our 'consent law' is neatly packaged in the Mental Capacity Act] the simpler 'either obtain genuine informed consent from your patient before you intervene, or if the patient is legally unable to consent ensure that there is a properly-considered and truly defensible best-interests decision justifying the intervention' to the various 'shared decision-making' models which are being promoted, it seems clear that this change must happen.
Rapid Response:
More Transformation than Mutation I feel: 'paternalism' to 'genuine informed consent'.
In her response of 17 July, Julie Haesebaert uses the word mutation to describe the current shift away from 'doctor knows best' and a top-down hierarchical approach to healthcare, towards a more complex 'care model' with the patient's decisions assuming priority, and much greater dispersal of involvement in the patient's care, etc. I think 'mutation' carries with it an implication of change without planning - 'randomness' - and this change is I believe better described by the word transformation: it is not a 'random' change, and is at least in the UK being driven by recent court rulings which stress that society now expects clinicians to respect 'the individuality and autonomy of patients'.
Put simply, we should now be an era of genuine informed consent: an era in which clinicians offer treatments and inform patients about prognoses, and patients decide which offer(s) to accept. Running alongside that change from paternalism to autonomy, is an acceptance of a greater role for lay carers: in reality, the traditional distinction between healthcare professionals and family carers is logically [and I believe legally] unsupportable in many situations, as I have attempted to illustrate with my 'Anne, David and Dr Jones' scenario (refs 1 and 2).
This change is a challenge for policy creators, as I have recently pointed out (ref 3) - but while I much prefer [for England where our 'consent law' is neatly packaged in the Mental Capacity Act] the simpler 'either obtain genuine informed consent from your patient before you intervene, or if the patient is legally unable to consent ensure that there is a properly-considered and truly defensible best-interests decision justifying the intervention' to the various 'shared decision-making' models which are being promoted, it seems clear that this change must happen.
1 https://www.dignityincare.org.uk/Discuss-and-debate/Dignity-Champions-fo...
2 https://www.dignityincare.org.uk/Discuss-and-debate/Dignity-Champions-fo...
3 http://www.bmj.com/content/358/bmj.j3257/rr-4
Competing interests: No competing interests