The comments by Hamilton and colleagues are timely. Since the legal rules governing surgical practice are as pertinent as the physiological and pathological rules which we derive from basic sciences, there is a powerful argument for ensuring that all surgeons, at whatever level, have adequate formal training in the current law.
If difficulty is encountered, a surgeon should seek advice, and the local Clinical Ethics Committee may be an appropriate source.
The patient safety alert to which Hamilton and colleagues refer gives a rather low standard when applied to matters of consent. This is because there is no requirement that the nominated deputy should be capable of performing the procedure in question. Therefore, under such a standard, it would be possible that a patient's consent would be obtained by an individual who is ill-equipped to provide it.
It is accepted that the survey may indicate woeful ignorance amongst surgeons when it comes to the issue of consent. Nevertheless, this survey needs to be taken with some caution. Psychiatric patients may be perfectly competent to provide consent providing that their psychiatric state has no bearing on the decision of whether surgery is appropriate. In the case of Re C [1994] 1 All ER 819, a schizophrenic Broadmoore patient was held to be entitled to refuse to have his leg amputated. This man had an illness which caused him to believe (erroneously) that he was a world-famous surgeon; however, the court found that he understood the nature and purpose of amputation and realised that he might die of the underlying gangrene if he refused treatment. It is salutary to note that the amputation proved unnecessary and his infection was successfully treated with antibiotics.