Patients should be able to choose between two different types of giving consent when agreeing to NHS treatment, a leading expert on medical ethics has proposed.
John Harris, professor of bioethics at Manchester University and joint editor in chief of the Journal of Medical Ethics , told a public meeting in Manchester last week on the doctor-patient relationship that introducing a two tier system of patient consent could make life easier for doctors and patients—and reduce mounting NHS legal bills.
"Informed consent is a lost cause, a hopeless ideal. We should now offer a choice between simple and informed consent. Most people would opt for the former and be happy for their doctor to decide whether and how to proceed with treatment—and thereby agree to have no comeback if things went wrong. This would give doctors back some professional control and also protect the NHS against litigation," he said.
Professor Harris’s comments arose during a panel discussion at the first of a series of five public meetings called by the General Medical Council’s Standards and Ethics Committee as part of its review of Good Medical Practice . This document forms the foundation of all GMC guidance, provides the framework for undergraduate medical education, underpins the processes for doctors’ appraisals and revalidation, and is used to assess doctors’ fitness to practice when complaints are made to the GMC.
A fellow panel member, Phil Hammond, a GP whose column "Doing the Rounds" in the satirical magazine Private Eye was among the first to highlight the poor state of heart surgery on children in Bristol in the early 1990s, agreed that pressure to gain patients’ consent may be getting out of hand.
"As doctors we’re becoming like financial advisers, setting out all the possible options for treatment but forcing all the choice and uncertainty involved in making a decision about it on the patients themselves. When my stepfather was about to be thrombolysed recently, the nurse was standing there reading out all the possible side effects to him, as she was required to do. Is this really the way we want things to go?" he asked. Good Medical Practice , first published in 1995, was last revised in 2001. The GMC ordered a review in June 2004, in the wake of the Bristol, Alder Hey and Shipman inquiries, so that the document would be "up-to-date, fit for purpose and contain principles that are held to be important by doctors, patients and the public."
Views from all five meetings will be incorporated into the consultation procedure on a new draft of the document, which is set to end on 30 November. The next meeting will be in London on 27 October, then Cardiff (21 November), Edinburgh (22 November), and Belfast (23 November).
Doctors interested in attending the meetings should email their name and postal address to gmplondon@gmc-uk.org (for the London meeting), gmcwales@gmc-uk.org (for Cardiff), or gmcscotland@gmc-uk.org (for Edinburgh and Belfast). The new draft of Good Medical Practice can be found at www.gmc-uk.org