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‘Fully informed’ consent is a fallacy

5 June, 2018
Daniel Sokol
Daniel Sokol

‘Fully informed’ consent is a myth and it is impossible to tell a patient everything there is to know about a particular intervention or procedure, barrister and medical ethicist Daniel Sokol will tell delegates at the joint UKRCO 2018 (UK Radiological and Radiation Oncology Congress) debate on Wednesday 4 July.

Entitled ‘Knowledge: How much is too much?’, the session will be chaired by Paul McCoubrie, Consultant Clinical Radiologist, North Bristol NHS Trust.

“What is your role? Where are the limits or boundaries? Is your role, say, limited to identifying a potentially significant abnormality in an image or a scan, or does it extend to deciding what action to take, if any, once these potentially significant abnormalities have been identified? Or is that last task somebody else’s role? In fact, the whole debate may be one about the scope of responsibilities,” Daniel says.

Author of a regular column for the British Medical Journal on ethico-legal issues, as well as three books on ethics and the law, he proposes that a helpful test to use might be if a practitioner decides to ignore an incidental finding that is arguably significant, and it turns out it was indeed significant, would you be happy to justify your decision in front of a fitness-to-practice tribunal?

“Would you be on solid ground, clinically speaking? How would your professional body, and your eminent colleagues, respond to your argument for non-disclosure? Would they support you or would they suddenly disappear, leaving you isolated? How would the general public respond?,” he will ask delegates.

“Would an ordinary, sensible patient be aggrieved at not having been told about this incidental finding when fully appraised of the significance of it?”

As an example, he will cite a recent case where a daughter wanted to donate a kidney to her father, and tests revealed that although the transplant was possible, he was not her biological father.

“There is always an element of selection when doctors disclose information to patients; a sorting out of what’s pertinent and what isn’t in the particular circumstances of the patient. That will involve the exercise of judgement and I suspect that will be the dominant word in this debate: ‘judgement’.”

The guiding star for all clinicians, he comments, should be the best interests of the patient. That is the overriding objective. As a rule of thumb, the patient himself or herself is the final judge as to what counts as being in their best interests.

“This is why the law requires doctors to provide patients with relevant information so that they can make their own decisions as to what’s best for them. The default position, in my view, is that ‘incidental findings of arguable significance’ should be shared with the patient, but not dumped on him or her. Patients need to be guided as to what to do with that information.”

One way to avoid problems, whilst respecting patient autonomy, Daniel will suggest, is to warn the patient in advance of a test or investigation that, occasionally, there are incidental findings and to ask ‘would they want to know if any are found’?

About UKRCO 2018
UKRCO, organised on behalf of the Society & College of Radiographers (SCoR), the British Institute of Radiology (BIR) and the Institute of Physics and Engineering in Medicine (IPEM), will be held at the ACC and Exhibition Centre in Liverpool from 2-4 July.

The three day event represents co-operation between the leading professional organisations and the utilisation of a vast body of data in diagnostic imaging and radiation oncology across many professional disciplines and industry. It is aimed at all those involved in the field of radiological science and radiation oncology.

This year’s theme, ‘Disease and Diversity’ offers delegates a comprehensive and challenging scientific and educational programme, comprising a wide range of sessions and formats

More information and to register

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