The evolution of informed consent

Informed consent and the changes in what is expected over the 21st century provide an instructive case study of the mutual influence on one another of medical law and medical ethics. Over the years we have moved from a doctor-centred standard to a patient-centred standard and from a one-size-fits-all patient-centred standard to a more individual requirement that engages with the needs of a particular patient It is unreasonable to expect those changes to be reflected in anything less than an extended conversation in which the health care professional gives out some version of what a reasonable patient would expect to hear from an informed health care professional and then responds to the patient's questions as informatively and helpfully as he or she can. It is therefore convenient to refer to spontaneous and responsive disclosure as a very concrete implementation of the health care professional-patient partnership that is contemporary health care and at the heart of health care ethics.     

Problems of long-term informed consent

This study addresses problems arising with informed consent for long-term maintenance pharmacotherapy. Obtaining patient consent to neuroleptic treatment, with the risk of tardive dyskinesia, has raised questions about long-term recall and the competence of psychiatric patients as a special population. The subjects were 32 adult outpatients, 16 were followed in the psychiatric clinic and 16 in the rheumatology, pulmonary, and neurology clinics. Structured interviews with these patients dealt with knowledge about relevant short-term and long-term medication side effects. Interview results were used to compare psychiatric and medical groups with respect to overall levels of comprehension. Two results were striking. 1. There was a remarkable similarity in the degree of comprehension between psychiatric and medical outpatient groups; this suggests that psychiatric patients need not be considered any less competent than medical outpatients in assimilating necessary medication information. 2. Patients in both groups were knowledgeable about short-term side effects, usually as a consequence of personal experience with them. However, their knowledge was consistently inadequate with regard to potential long-term side effects from their maintenance medication. Current informed consent doctrine may presume a degree of recall and comprehension beyond the capabilities of most patients. The development of an appropriate doctor-patient relationship that reconciles the need for consent with patient limitations remains an important challenge for clinicians.     

The future of informed consent in British common law

Within the common law world, the use of the term informed consent implies the American doctrine. Informed consent as a doctrine is not part of the law in the United Kingdom. However, it is possible to predict a way forward in disclosure cases yet to be heard in the courts of the United Kingdom. These predictions are based on current developments in the common law in the United Kingdom as well as those in Canada and Australia, on the European Convention on Human Rights and Biomedicine and on trends within the medical profession itself in the light of the Bolam test.