Incomprehensible consent forms:Plain English is important
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7505.1450 (Published 16 June 2005) Cite this as: BMJ 2005;330:1450All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Sir- This problem is common to many countries and languages. For
professional reasons, I read many clinical documents from different
hospitals. A written consent form is usually found. There are two main
kinds of forms. One form is very concise, nothing is really explained, but
the doctor is allowed to do what he thinks better for the patient. Another
type of form is much more technical, to the point that only a specialist
of that disease can understand what is written. In some occasions, I had
difficulties in understanding. Moreover, medical councils did not decide
yet what is important in practice to write down in a consent form.
Therefore, the problem concerns both the content and the style of this
very particular communication. In my opinion, the doctor should use some
minutes to explain the case to the patient, and write this conversation un
the form. After all, we are doctors only because there are patients.
Competing interests:
None declared
Competing interests: No competing interests
Informed consent is not possible.
The debate relating to consent forms instigated by Pothier's letter,
and responses by Dingwall, Curtis and Roberts, appear to be arguing the
wrong point. The consent form itself should not be focus of consent -
indeed, consent may be adequately undertaken verbally. The document
provides a more robust source of evidence that consent has been aquired,
but not proof of it. It also enshrines a routine within the system to
ensure appropriate efforts are undertaken to aquire consent, and serves as
a reminder of this obligation. Doctors continue to treat consent in the
"functionalist" and administrative way described by Alderson and Goodey(1)
as "a polite ceremony". Surely we need to concentrate more on
communication skills? Perhaps not: Schneider and Farrell(2)
describe their study of forty patients upon each of whom was lavished 1-2
hours of time and considerable effort to obtain informed consent in
relation to having or not having prostate cancer screening. It was clear
to the researchers that proper understanding of the issues was not
achieved and that decisions made were often instantaneous, illogical (such
as reference to a film star who had had a successful treatment of another
cancer or dismissal of statistics because they were more unlucky than
others), or with a clear misunderstaning of the facts. Numerous studies
exist that show, despite best efforts in terms of information provision
and explanation, many patients still cannot remember much of the
information imparted to them. Yet, doctors are under obligation in law(3)
and professional guidelines to ensure, amongst other things, patients have
(a)the capacity to consent (b)enough relevant information to consent and
(c) to have understood this information and be able to come to a
conclusion.
The anecdotal and real evidence suggests that to achieve this
consistently is impossible. It is time for the medical and legal
professions to understand that it is not the failings of doctors that
limits informed consent. The requirements of informed consent have been
derived in the absence of the evidence which shows that these apparently
reasonable stipulations are, perhaps unexpectedly, not possible. Indeed, I
am not aware of any evidence that proves informed consent is consistently
attainable. Perhaps spending an hour for each patient may work, but would
cut clinics down to a few patients and add five years to waiting lists (or
require ten times more staff).
What is required, therefore, is an open debate on resolving this
issue. The first step is to separate ideologically and physically the
consent process from the documentation of that consent. However, informed
consent may be, as many of us suspect, an impossible ideal.
Alderson P, Goodey C. Theories of consent. BMJ, 1998; 317: 1314.
In "Law and Medicine (Current Legal issues vol.3)", Oxford, 2000,
pp107-126
Chatterton v Gerson [1981] 1 All ER 257
Competing interests:
Currently a final year student in medical law undertaking thesis on consent.
Competing interests: No competing interests