The competent adult

The sane adult patient has a right to accept or refuse treatment without explanation. The doctor's obligation is to provide information of a type which explains the nature, risks, and benefits of the chosen therapy, and also any alteratives. Different legal systems require different standards to be met. In the United Kingdom, the doctor's behavior will be judged by a test which depends effectively on the standard set by his or her professional colleagues, although the court reserves the right (seldom, if ever, exercised) to declare that medical practice is not adequate ( Bolam v. Friern Hospital Management Committee [1957] 2 All ER 118 (England); Sidaway v. Board of Governors, Bethlem Royal Hospital [1985] 1 All ER 643 (H.L.)(UK)).

In some states in the United States, the test which is applied is that of the 'prudent patient'. In these states the doctor's responsibility is to provide the information which the 'prudent patient' would want to know before reaching a conclusion ( Canterbury v. Spence 464 F 2d 772 (US)).

Most common-law jurisdictions have followed the United Kingdom test, although recently an Australian Court ( Rogers v. Whitaker [1993] 4 Med LR 79 (Australia)) declared this test to be insufficient to meet the requirement that 'Every human being of adult years and sound mind has a right to determine what shall be done with his own body...' (Schloendorft v. Society of New York Hospital 105 nE 92 (US)). This case may mark the beginning of a move away from the assumption that it is for the doctor to decide what the patient needs to know and start a trend towards recognizing that the decision is one which is personal to the individual patient who may therefore require information which the doctor does not regard as relevant.

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