Blog 94 Obtaining Informed Consent

On 19 July 2010 I had been blue-lighted to Addenbrooke’s Hospital, Cambridge, because my General Practitioner was concerned I was losing consciousness. Following triage, I was scuttled away for a scan of my brain. (See image )  Whilst I was fading into a coma, a doctor told my wife Anne that it was necessary to drill holes into my skull to remove collections of blood (subdural haematomas) which were pressing on my brain. He then departed, soon to reappear later flourishing a clipboard and a pen.

 He offered me the pen, his body language suggesting I should sign the ‘Informed Consent’ document. 

Note blood between skull and brain on left

This is an essential legal form, which must be signed by all patients prior to healthcare interventions. The principle of such consent plays a key part in medical ethics and international human rights law. Not least it provides litigation perspectives for both doctor and patient should anything go wrong. However, for consent to be valid, it must be voluntary and informed and the person consenting must have the mental capacity to make the decision.

 Lying in my semiconscious state, I was happily volunteering to sign the form but was unable to do so. By then my speech and writing had gone completely, indeed understanding anything was impossible, so I was unable to explain my dilemma to this insistent young doctor.   

 In my personal waning world, I remember thinking that it was a bizarre request. Presumably the doctor was part of the team monitoring my deteriorating mental state so must have had an inkling that writing might be difficult - or even impossible. Further, from his medical training he must have known that ‘consent’ obtained in these circumstances was not ‘informed’ consent.

And unfortunately at this time I was alone because my advocate, Anne, had taken an opportunity to visit the loo after sitting with me for hours.

 But he wanted a signature. So, with no idea what I was signing, I indicated for him to hold the clipboard firmly. Then, with effort, I grasped the pen like a dagger in the palm of my right clenched fist and had a go. Large unrecognisable scribble was placed diagonally across the entire form. He then hurried away, apparently happy that I understood all the benefits, the many complications and risks associated with the proposed surgery on my brain and that I had consented to the operation!

 

Thankfully my faculties returned post-op, but whenever I recall this tale, it is usually met with raised

eyebrows, as folk reflect upon a contradiction within the spirit of the word ‘informed’. I am delighted to have my life back but had that not been the case a huge legal wrangle might have resulted, centered on the word ‘informed’.

 Making sure that consent is truly informed is very important. A surgical friend of mine tells me that many patients don't take it seriously enough.  Incredibly, some will sign the form without reading  it, much as one might sign a form when hiring a car, knowing that you don't get the service you want unless you agree to the numerous pages of small print. He mischievously suggests that if he presented patients with a form saying ' Proposed operation - Removal of head and all 4 limbs', many would sign it without a second thought.

  Submitted by Ian Garmston  from Newmarket, Suffolk.

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