11.2 Listening
relationship between the doctor and the patient outside the experimental situation. It was only with the issuing of the Declaration of Helsinki in 1964 by the World Medical Association that this point was addressed. The declaration stated that not only must participation in any research be a voluntary choice, it must also be an informed one. A useful editorial from the BMJ on the subject explains how it came about and its importance. It is fair to say that the declaration has provided the basis for the development of the medico-legal ethics we apply today. This had important implications for all doctors, because for the first time, it was recognized that there was a need to obtain informed consent from patients for professional care which included research. So what about examples in practice of obtaining
informed consent to treatment? Obtaining written consent to perform an operation is a routine task, undertaken on a daily basis. Some doctors may say that, in practice, its only real function is obtaining proof of consent for invasive actions, which could otherwise be legally considered assault. They feel that the patient does not have enough medical knowledge and expertise to evaluate the risks and benefits of a procedure, even when they have sufficient information to do so. In the opinion of this section of the medical profession, it is only the doctor who is in a position to make a fully informed, objective judgment. I simply cannot agree with this position, which can only be described as misguided paternalism. I mean, it’s like the doctor behaving as a parent, not a professional advisor. Ensuring a patient is fully aware of the risks and benefits of a procedure is not only a legal requirement in order to prevent accusations of medical negligence on your part; it is also fundamental to the ethical principle of patient autonomy. Some doctors may believe that by signing the consent
form, the patient indicates that they have understood the information they have been given. The evidence shows that this may not be the case. A very useful article by Sudore et al. published in 2006 in the Journal of General Internal Medicine outlines an experiment carried out to measure how much of the information in consent forms was understood by patients. Briefly, the authors explain how in fact only 28% of patients presented with a highly simplified medical consent form fully understood it the first time. In my view, this very strongly supports the need for greater care when gaining consent to procedures. In particular, it is necessary to provide the information in a way which the patient can understand and to check that they have indeed understood what you have told them. With respect to Sudore’s study, she points out that regardless of how highly literate anybody is, we cannot assume that they understand the medical consent information we provide them with. She has no doubt that this is one of the most important factors which legislators have to consider in relation to patient consent. There are also a number of practical considerations
to take into account when obtaining patient consent for treatment, which I am only going to touch on here. If you want to look more closely at these, a very good overview can be found in the Student BMJ (I’ll give you the URL later). Perhaps the most important consideration is that the patient should be legally entitled to give their consent to the procedure. As a rule, all adults can give consent,
except for those whose reason is impaired, for example, by drink or drugs or as a result of mental illness. Minors in the US cannot give consent, while those in the UK, Canada or Australia can if they are judged mature enough, according to what is known as the ‘Gillick competence’. Now, I’m going to pause at this point and …
D
RESOURCES p. 128 11.2 Model Cornell notes
1. Set students to work in pairs, and tell them to compare the notes on page 132 of the Course Book with their own notes. Help them to identify any common diff erences and the reasons for them (e.g., they may not be familiar with some of the vocabulary).
11.2_D
T e model Cornell notes are also provided in the PDF.
2. Check to make sure that students understand the content. Ask students to complete the Review and Summary sections individually, and then give them time to compare their work with a partner.
SKILLS BANK 9.1 Using the Cornell note-taking system
If students need a reminder of how to complete the Cornell notes, point them back to Skills Bank 9.1 and their work in Unit 9.
Model answers See table on the next page.
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