Informed consent is a state reached between doctor and patient after a full discussion of the diagnosis, treatment, risks, and what might happen if there was no treatment. The doctor must disclose things about treatment that are important, and the patient has an obligation to inform himself. This can be done in nonmedical words. The patient needs to know the discussion is an informed consent so that he can say yes or no to the treatment. Detail is most required when there is no rush to decide, and least needed in emergencies.
Added to informed consent is “material risk”.
“Material effects, risks and side effects are those which are either common, even if relatively inconsequential, or those which are less likely to occur but have very serious consequences if they do occur. The Supreme Court of Canada says that even risks and side effects which are very rare must be explained to the patient if the consequence of their occurrence is paralysis or death. The information a patient must be offered before giving consent to a treatment includes those material effects, risks, and side effects together with the information that a reasonable person would wish to have in making a decision to have or forego the procedure. In addition, any relevant questions the patient may have should be answered as honestly and fully as possible (1).
Let me now outline how I think we should practise medicine and surgery.
“A doctor should follow the golden rule and treat patients the way he would like to be treated if sick.”
“He should always remember his two roles. First is diagnosis, explanation and treatment, the next is that of a sympathetic physician who never gives up hope, who encourages when life seems the darkest, who knows his patient’s individuality and shows an active compassion for the vagaries of life.”
“He is always the patient’s advocate in a world where fate can change a dream in a hour, and is able to show that life may not be hopeless after all, with optimism, and a positive medical plan.”
There is conflict between “material risk” and a doctor’s unspoken philosophy for sagittal fractures of the maxilla. Why did the Supreme Court write this when it is sure to be a law honoured more in its neglect than its observance? The only reason I can think of is the Court’s desire to see paralysis and death (two res ipse loquitur situations) compensated. Discussing them before treatment is a way for them not to be recompensed. Did the Supreme Court know that doctors would not discuss these things routinely and therefore make it easier for recompense if they did occur?
Would it not be easier to have a form of `flight insurance’ for patients who are unfortunate enough to suffer paralysis or death while undergoing medical treatment?
The “material risk” law should be dropped now as impractical and against the basic tenets of medical practice. It is unworkable, cumbersome and unworthy of a pragmatic society. The rights of the few unfortunate patients who suffer misadventure should be protected some other way but not through the concept of `material risk’.
I hope that those who framed the law will interpret this with `all due respect’, keeping in mind that this term can also mean, “all the respect that is due”.
John R Taylor MD
Toronto
REFERENCE
1. College of Physicians and Surgeons of Ontario, Member’s Dialogues, July 1995, Informed Consent’, Page 11.
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