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- W2115084376 abstract "I enjoyed McCombe and Bogod's editorial 1 on the evolving legalities of consent. However, I have concerns that the recent Montgomery judgment may have unforeseen and potentially negative consequences for day-to-day anaesthetic practice. I wholeheartedly support their Lordships' recognition of the importance of patient autonomy. Anecdotally, their suggested framework for gaining consent is similar to what many doctors have been doing for years: namely, presenting a patient with the reasonable options, discussing the pros and cons of each, and then coming to a joint decision about how best to proceed. My concern regards the assertion that “The doctor must find out which risks may be relevant to each ‘particular patient’ and tailor the consent process accordingly.” Telepathy aside, how can clinicians ascertain the risks a particular patient would find relevant without actually listing all those risks? Human beings, doctors included, are irrational and illogical creatures, and it is surely impossible for physicians to judge what a patient would consider a material risk. Undue importance is often placed on serious, but rare, risks – such as the tiny risk of death or small risk of awareness under general anaesthesia – while patients remain relatively unconcerned about surgical morbidity and mortality. By guessing, rather than asking, which risks a particular patient would find significant, do we not run the risk of inadequately informing patients, and therefore of potential legal consequences? Or would evidence that we tried, in good faith, to define the risks relevant to a particular patient – even if we get it completely wrong – be enough to formulate a legal defence of our practice? I fear that the Montgomery judgment has put us on the slow but inexorable road to consent booklets for anaesthesia and surgery, with page upon page of lists of potential risks to be read before an operation, so that a patient can be considered fully informed and able to consider which risks are material before discussing them with a clinician. These do already exist in other areas of medicine – for example, I recently received one before an endoscopy. On the plus side, we can look forward to increased time in our job plans for pre-operative assessment, given the inevitable rise in questions from, and explanation to, patients. Finally, I am often asked to comment on patients' fitness for anaesthesia. Aside from the fact that fitness is actually for surgery, rather than for any intervention I might provide, my answer is usually that if the patient requires an operation, is willing to accept the risks, and cannot be physiologically optimised any further, we should proceed. Extending deference to patient autonomy might at least have the welcome side effect that, as a profession, we will no longer refuse indicated surgery because the clinicians involved are uncomfortable with risks that our patients might willingly take." @default.
- W2115084376 created "2016-06-24" @default.
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- W2115084376 date "2015-11-11" @default.
- W2115084376 modified "2023-09-28" @default.
- W2115084376 title "Consent – implications for day‐to‐day anaesthetic practice" @default.
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- W2115084376 doi "https://doi.org/10.1111/anae.13296" @default.
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