Informed consent in surgery.

Abstract

The year 2014 marks the 100th anniversary of the famous decision made in New York by Justice Benjamin Cardozo in the Mary Schloendorff case [1]. His decision, condemning the surgeon for the removal of an abdominal fibroid tumor without the expressed consent of the patient, paved the way, together with other sentences [2–7] (Table 1), for the development of the defense of patients’ rights, in tandem with major developments in the fields of surgery and anesthesia during the 20th century. In the field of twenty-first century, it is wholly accepted that the traditional paternalist relationship between the patient and his or her surgeon has been superseded by a new type of relationship in which the patient has to play a participative role, with the aim of the patient-physician relationship a more interactive dialog that makes it possible to provide the patient with the information they need prior to being operated on, and to allow the surgeon to receive feedback from the patient. This new concept of the patientphysician relationship has come about because the users of healthcare systems are more mature, are more informed by different sources, in which the Internet plays an increasingly significant role, and wish to participate actively in their healthcare. For this reason, it is essential to establish a more fluid dialog between the patient and physician. Within this new context of the patient-surgeon relationship, informed consent plays a highly significant role. For patients waiting to undergo surgery, obtaining informed consent is the final step in the information process for the surgeon, and giving informed consent is an important decision that the patient must make freely and independently. For informed consent in surgery, the legal principle emphasizes that the patient is an independent adult who has the capacity and the competence to authorize what is going to be done to their body and mind. Therefore, any operation that may infringe upon this principle is not only considered illegal and liable to result in lawsuits for unlawful injury caused to the patient, it is also ethically unacceptable. In Spain, Law 41/2002 [8] defines informed consent as ‘‘the free, voluntary and conscious agreement of a patient, stated in the full use of their faculties after being suitably informed, so that an action may be undertaken that affects their health.’’ The general concept of this Law is similar in all Western nations. It is a legal term that underlines the voluntary authorization granted by a patient who fully understands the risks involved in the performance of a medical or surgical treatment. Thus, the former paternalistic relationship with the physician gave way during the 20th century to the current situation whereby patients are able to make decisions characterized by patient autonomy, shared decision-making, self-determination, and patient value system. The aim of the patient-physician relationship is to respect the patient’s interests and system of values and, in general, guarantee the patient’s rights. Experts increasingly agree that informed consent is a process in which the surgeon plays a truly important role. This role has been called ‘‘the art of obtaining informed consent in the clinical setting’’ [9]. All surgeons, including those in training, must know this art, and, in the opinion of Childers et al. [9], ‘‘informed consent must be an integral part of every surgeon’s daily practice.’’ This process has significant ethical and legal aspects, but it also plays an important role in modern surgical practice. The surgeon is M. A. Cainzos (&) S. Gonzalez-Vinagre Department of Surgery, Hospital Clinico Universitario, c/Vidan, s.no, 15706 Santiago de Compostela, Spain e-mail: miguelangel.cainzos@usc.es