Seeking patients' consent in anaesthesiology: consent in clinical practice

Abstract

SummaryThe article explores the historical, legal and philosophical background and justification of informed consent. Anaesthesiologists have a responsibility to obtain separate informed consent, both to prevent litigation and to satisfy the requirement of rationality and respect for personal autonomy. The three-tiered model—competence, information, and consent—is described. The inherent nature and current practice of anaesthesiology problematizes proper informed consent. This includes timing, time-constraints, managed care, same-day surgery and emergencies. Wider use of pre-op clinics is advocated. There is a move towards written consent. Properly documented consent relieves the burden of proof, yet is neither a legal requirement nor confirmation of a proper interview. Authors generally advocate written consent in obstetric analgesic practice. Pre-printed forms do not replace an interview. The interview should be tapered to the needs and requirements of the particular patient. The reason why information is provided should be explained. Appropriate illustrative material and aids are advised. The uninformed patient cannot give consent. The supply of information empowers the patient to engage in an interactive conversation with the anaesthesiologist, and broadens the base for further discussions and questions. At least a full explanation of the procedure and techniques (particularly of all invasive procedures), information about the chances of success, incidence of complications, risks involved, available alternatives, the relative risks and complications of alternatives, costs, and the role of the anaesthesiologist is required. Particular reference to the training of students is mandatory. Separate consent is required for all research purposes.