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Review
. 2010 Jul;34(7):1406-15.
doi: 10.1007/s00268-010-0542-0.

A review of surgical informed consent: past, present, and future. A quest to help patients make better decisions

Wouter K G Leclercq  1 , Bram J Keulers, Marc R M Scheltinga, Paul H M Spauwen, Gert-Jan van der Wilt
Affiliations
Review

A review of surgical informed consent: past, present, and future. A quest to help patients make better decisions

Wouter K G Leclercq et al. World J Surg. 2010 Jul.

Abstract

Background: Informed consent (IC) is a process requiring a competent doctor, adequate transfer of information, and consent of the patient. It is not just a signature on a piece of paper. Current consent processes in surgery are probably outdated and may require major changes to adjust them to modern day legislation. A literature search may provide an opportunity for enhancing the quality of the surgical IC (SIC) process.

Methods: Relevant English literature obtained from PubMed, Picarta, PsycINFO, and Google between 1993 and 2009 was reviewed.

Results: The body of literature with respect to SIC is slim and of moderate quality. The SIC process is an underestimated part of surgery and neither surgeons nor patients sufficiently realize its importance. Surgeons are not specifically trained and lack the competence to guide patients through a legally correct SIC process. Computerized programs can support the SIC process significantly but are rarely used for this purpose.

Conclusions: IC should be integrated into our surgical practice. Unfortunately, a big gap exists between the theoretical/legal best practice and the daily practice of IC. An optimally informed patient will have more realistic expectations regarding a surgical procedure and its associated risks. Well-informed patients will be more satisfied and file fewer legal claims. The use of interactive computer-based programs provides opportunities to improve the SIC process.

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Figures

Fig. 1
Fig. 1
Landmarks in the history of the IC process: a timetable
Fig. 2
Fig. 2
American Review: A Whig Journal of Politics, Literature, Art, and Science (December 1845); publication of Edgar Allen Poe’s “The fact in the case of M. Valdemar.” Available at http://digital.library.cornell.edu/cgi/t/text/text-idx?c=amwh;idno=amwh0002-6
Fig. 3
Fig. 3
Cardozo, Benjamin Nathan. Online photograph from the Encyclopædia Britannica. Available at http://www.britannica.com/eb/art-96738
Fig. 4
Fig. 4
Nuremberg Trial: the 23 defendants in dock during the doctors’ trial. Available at http://www.law.umkc.edu/faculty/projects/ftrials/nuremberg/docdef.jpg
Fig. 5
Fig. 5
The elements of IC
See this image and copyright information in PMC

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