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The consent that is never sought

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Aside from death and taxes, life’s only other certainty is that you have a body, over which you have complete sovereignty and which is protected by law, including human rights legislation. If somebody attacks you, the assailant will be prosecuted and punished – indeed, any action on your body carried out without your full consent is a criminal offence.

The only people who seem to disregard this absolute right are doctors, as our Special Report this month explores ( They pay lip service to the legal concept of consent, especially before surgery and other interventions, but their requirement is nothing more than a signature at the end of a long document, almost never read by the patient.

However, the doctor has to negotiate two hurdles before any procedure can begin: not only must he seek consent, that consent has to be fully informed. In other words, the patient should understand why the procedure is needed, its success rate, its risks – no matter how small – and any alternatives.

Of course, true informed consent rarely happens. The doctor argues that he doesn’t have time to go into enormous detail with every patient, and some patients feel they shouldn’t bother the doctor who always seems to be too busy. Some doctors still hold to the paternalistic belief that they know best, and that talk of risks would only worry the patient unnecessarily. Unless the risk becomes an actuality, of course, but by then it’s too late.

Doctors sometimes don’t bother seeking consent of any kind, informed or not. The most routine practice by any doctor is the writing out of a prescription – but he almost never points out the drug’s risks or success rate.

Radiologists don’t even bother with any pretence of consent. As a medical screening is part of an investigative process, usually requested by another doctor, the radiologist perhaps believes that consent is not required. Yet each screening subjects the patient to some level of radiation, and, in the case of a CT (computed tomography) scan, that can be similar to levels monitored at Hiroshima when the A-bomb was dropped.

If doctors did follow their legal requirement to achieve truly informed consent, most surgical procedures would never happen, and some patients would seek out safer alternatives if they were told the real risks of prescription drugs.

Doctors know this, of course. That’s why they don’t tell.

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