Most patients have limited awareness of the legal implications of signing or not signing consent forms, with most believing they are designed to protect hospitals and doctors rather than patients, a British study has concluded.
"Current consent procedures seem inadequate as a means for the expression of autonomous choice, and their ethical standing and credibility can be called into question," the researchers said.
The findings were based on questionnaires completed by more than 700 women within a month of having elective or emergency surgery in an obstetrics and gynaecology department. The consent forms were standardised and used throughout English hospitals, having been introduced to make the process more structured and patient-focused.
However, one in five patients did not know whether they could change their minds after signing the form, and one in six thought it removed their rights to compensation if something went wrong. More than a third were unsure if the operation could be performed if they refused to sign the form, and 17% incorrectly thought it could. There were 23% who did not know whether the operation could be performed to save their lives if they were unable to sign the form. Most were unaware that their next of kin could not sign the form on their behalf if they were unable to do it themselves.
"Only 41% of patients thought the consent form made their wishes known," the study reported. "Almost half (46%) believed that the main function was to protect the hospital from litigation, and 68% thought it gave doctors control over what happened."
The role of consent, in ethical terms, was to safeguard patients' autonomy. Previous work had suggested that many patients viewed it as a ritualistic and bureaucratic hurdle, might feel pressured by having to give written consent, and reported that they did not read or understand the form before signing it.
"There is a substantial disparity between the ideals of the consent model as depicted in the bioethical model and how it is perceived and experienced by patients," the researchers said. "The findings are disconcerting for healthcare professionals and patients alike."
Reference
Akkad, A. Jackson, C. et al. 2006, 'Patients' perceptions of written consent: questionnaire study', BMJ, vol. 333, pp. 528-530.
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