'Medical consent; striking the right balance between shared decision-making and shared responsibility': A win-win scenario if done well.

Abstract

Agarwal and colleagues illustrate in their letter1 how balancing shared responsibility and shared decision-making can help achieve positive clinical outcomes as well as reduce the risk of litigation, which was the focus of our paper.2 Their case of a young girl fighting metastatic bone cancer and severe coronavirus disease 2019 (COVID-19) infection on an intensive care unit (ICU) highlights the clear benefit of ensuring that treatment decisions are not made in isolation. Multilanguage animations to support family understanding of ICU and COVID treatment (www.explainmyprocedure.com/icu) have been developed and successfully used to improve family understanding in the face of restricted visiting on ICU.3 This resource may have helped overcome some of the challenges around shared decision-making in this environment. The approach taken by Agarwal and the ICU team, nonetheless, ensured that everyone was aware of the options and on board with the treatment offered. Critically they considered the patient’s unique characteristics (age, underlying illness, hobbies, family life, etc.) all of which are elements that would be considered in the process of seeking consent to treatment. They are to be congratulated for this, in what was clearly a complex and emotionally charged set of circumstances. Their letter makes the important point, that whilst one motivation in having patient-specific discussions about treatment is to meet the legal requirements of informed decision-making, the practical and medical benefit is that a patient is fully engaged in recovering rather than being over-reliant on the clinical team as a ‘passenger’ in the process.