Introduction

It goes without saying that therapy given without the agreement of a patient is ethically and legally unacceptable. No contemporary practitioner would proceed without any agreement from a competent patient—to do so would be an assault or battery. However, problems may arise when assessing the amount of information which is sufficient to ensure that the patient is adequately informed and able to make a meaningful decision.

Therefore the real problems are not about the need to obtain consent but rather about how real that consent actually is. The doctor who provides insufficient information may be held to have been negligent. In addition, there may be further complications when the patient is not a sane adult. Where the patient is a child, incompetent, or unconscious, different questions are raised which require careful analysis by doctors, based always on the principle that treatment given without the provision of appropriate information, and without an assent from the patient, must be the exception rather than the rule.

For this reason, it is important to remember that obtaining an agreement is much more than a legalistic hurdle to be overcome. It is a reflection of the doctor's respect for the integrity of his or her patient. Even the certainty of a cure is not sufficient to authorize the clinician to intervene without that respect being manifested. The crucial element is the sharing of information and not the outcome. Consent is only one of the possible outcomes of this process of information sharing. The patient may exercise his or her right to refuse treatment on grounds which can be entirely personal and which, in the case of the competent adult, do not need to be explained to, or understood by, the doctor (Re C (adult: refusal of medical treatment) [1994] 1 All ER 819 (England)).

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