Informed patients

SIR – James Le Fanu raises an important ethical issue in his piece on consent for clinical research and trials (Doctor’s Diary, November 20).

Thankfully, the law and professional guidance have moved from “doctors know best” to a more patient-centric model, where autonomy is king. It is important to make clear, however, that written consent is not the panacea, but simply evidence of a consent process.

Not all surgical procedures legally require written consent; in fact, such legislation is limited to specific procedures referred to in certain statutes, such as the Human Embryology and Fertilisation Act.

What doctors must focus on is having a full and open discussion with patients about their options and their concerns. While the signing of consent forms is regarded as good practice, it is not usually a legal requirement. Consent means more than a signature and is not a complete defence against claims alleging invalid approval. Dr Pallavi Bradshaw

Senior Medicolegal Adviser Medical Protection Society London SE1