Abstract
Background: Consent has been placed at the centre of doctor-patient relationships. Attempts to improve the consent process in medicine have drawn on bioethical and legal traditions. Current approaches to consent emphasise the provision of information and have, in the UK, resulted in a single standardised format and process for both elective and emergency situations. Investigation of patients' perceptions and priorities are important in understanding the quality of the consent process.
Methods: In this qualitative study, semi-structured interviews were conducted with 25 women. Eleven had elective and 14 had emergency operations in obstetrics and gynaecology. All interviews were recorded and transcribed verbatim. Data analysis was based on the constant comparative method.
Results: Participants' perceptions of surgery strongly influenced the meanings they gave to consent. Some, particularly those undergoing elective operations, wanted surgery. Others were uncertain of their desire for surgery or felt that it was imposed on them. Consenting was interpreted as a ritualistic legal procedure. There was an overwhelming tendency to view consent as not primarily serving patients' needs, although some advantages of the consent process were identified. Accounts made no reference to ethics.
Conclusion: Countering paternalism will remain difficult to achieve if issues surrounding consent continue to be debated between professionals without due effort to reflect patients' own views and values and to appreciate the circumstances under which consent is sought.
Full Text
The Full Text of this article is available as a PDF (75.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Agård A., Hermerén G., Herlitz J. Patients' experiences of intervention trials on the treatment of myocardial infarction: is it time to adjust the informed consent procedure to the patient's capacity? Heart. 2001 Dec;86(6):632–637. doi: 10.1136/heart.86.6.632. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bottrell M. M., Alpert H., Fischbach R. L., Emanuel L. L. Hospital informed consent for procedure forms: facilitating quality patient-physician interaction. Arch Surg. 2000 Jan;135(1):26–33. doi: 10.1001/archsurg.135.1.26. [DOI] [PubMed] [Google Scholar]
- Chan E. C., Sulmasy D. P. What should men know about prostate-specific antigen screening before giving informed consent? Am J Med. 1998 Oct;105(4):266–274. doi: 10.1016/s0002-9343(98)00257-5. [DOI] [PubMed] [Google Scholar]
- Chan Yvonne, Irish Jonathan C., Wood Stephen J., Rotstein Lorne E., Brown Dale H., Gullane Patrick J., Lockwood Gina A. Patient education and informed consent in head and neck surgery. Arch Otolaryngol Head Neck Surg. 2002 Nov;128(11):1269–1274. doi: 10.1001/archotol.128.11.1269. [DOI] [PubMed] [Google Scholar]
- Chassin Mark R., Becher Elise C. The wrong patient. Ann Intern Med. 2002 Jun 4;136(11):826–833. doi: 10.7326/0003-4819-136-11-200206040-00012. [DOI] [PubMed] [Google Scholar]
- Coulter Angela. After Bristol: putting patients at the centre. BMJ. 2002 Mar 16;324(7338):648–651. doi: 10.1136/bmj.324.7338.648. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dixon-Woods M., Findlay M., Young B., Cox H., Heney D. Parents' accounts of obtaining a diagnosis of childhood cancer. Lancet. 2001 Mar 3;357(9257):670–674. doi: 10.1016/S0140-6736(00)04130-1. [DOI] [PubMed] [Google Scholar]
- Dixon-Woods M. Writing wrongs? An analysis of published discourses about the use of patient information leaflets. Soc Sci Med. 2001 May;52(9):1417–1432. doi: 10.1016/s0277-9536(00)00247-1. [DOI] [PubMed] [Google Scholar]
- Gillon R. Medical treatment, medical research and informed consent. J Med Ethics. 1989 Mar;15(1):3-5, 11. doi: 10.1136/jme.15.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Habiba M. A. Examining consent within the patient-doctor relationship. J Med Ethics. 2000 Jun;26(3):183–187. doi: 10.1136/jme.26.3.183. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kelly Susan E. Bioethics and rural health: theorizing place, space, and subjects. Soc Sci Med. 2003 Jun;56(11):2277–2288. doi: 10.1016/s0277-9536(02)00227-7. [DOI] [PubMed] [Google Scholar]
- Meredith Philip. Patient participation in decision-making and consent to treatment: the case of general surgery. Sociol Health Illn. 1993 Jun;15(3):315–336. doi: 10.1111/1467-9566.ep10490539. [DOI] [PubMed] [Google Scholar]
- Veatch R. M. Abandoning informed consent. Hastings Cent Rep. 1995 Mar-Apr;25(2):5–12. [PubMed] [Google Scholar]
- Vohra H. A., Ledsham J., Vohra H., Patel R. L. Issues concerning consent in patients undergoing cardiac surgery-the need for patient-directed improvements: a UK perspective. Cardiovasc Surg. 2003 Feb;11(1):64–69. doi: 10.1016/s0967-2109(02)00057-1. [DOI] [PubMed] [Google Scholar]