Sir, – In his article (Opinion, November 3rd) Steven Young is scathing about the imposition of the requirements of informed consent on busy doctors. While it is important to acknowledge the heavy workloads of doctors and the challenges that may exist in terms of finding time to talk to patients about their treatment, these are matters for hospital management and administrative reform rather than rowing back on the important developments that have been made in terms of patient-centred care in recent years.
There are a number of issues in Mr Young’s article that require clarification. Firstly, the “new guidelines” of which he speaks were issued by the Royal College of Surgeons in England. There is already a National Consent Policy in place in Ireland since 2013.
Secondly, he refers to the ruling in the English Supreme Court known as the Montgomery case which he says will “heap misery” on the medical profession in Ireland. In addition to the fact that decisions of that court have no binding effect in this jurisdiction, Mr Young is mistaken in his contention that in England prior to this ruling, disclosure was left to the doctor’s discretion.
In reality, the case confirmed an existing trend towards a patient-centred test of disclosure.
More importantly, the patient-centred test has also been the test in law and in practice in Ireland for the last 15 years.
There is a well-established legal and ethical principle that people have the right to control their own life and to decide what happens to their own body. This means that consent must be obtained for any medical examination, treatment, service or investigation. The requirement for consent is recognised in Irish case law, the Constitution, and international and European human rights law. Choosing whether to undergo or to forego medical investigation and treatment requires the patient (not the doctor) to balance the potential risks and benefits of different approaches so the patient (not the doctor) can make an informed choice about what happens to his or her body.
Mr Young is sceptical that tying up so much of a doctor’s time repeatedly explaining all the nuances of an operation is the best way to use his skills. How else will a patient understand the procedure if the doctor does not explain the risks, benefits and alternatives? Is he suggesting that we return to the days when doctors decided what was best for the patient and withheld information about unpleasant risks that, in the opinion of the doctor, the patient need not know?
Finally, Mr Young asks whether some risks are not self-evident and therefore ought not be necessary to disclose.
The first European Health Literacy Survey found that 40 per cent of the Irish population have limited health literacy and recommended that health care professionals in Ireland should adjust their expectations in assuming the levels of health literacy of their patients.
– Yours, etc,
Pro DEIRDRE MADDEN
School of Law,
University College Cork.