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Consent – implications for day‐to‐day anaesthetic practice

explored, since this relevance is inherently subjective to the patient. Therefore, given the wide range of costs, implementing current recommendations requires that all possible adverse events be mentioned to all patients, since that is the only way of accurately estimating the implications of any intervention to any particular patient. We note that legal conflicts regarding consent have always been initiated in retrospect when the costs of a rare risk to that particular patient have been realised. Unless all events are explored in as many contexts as possible, such problems will continue to recur. We also note the admonition about presenting risks as percentages. To deny this is to deny a fundamental property of risk; these are percentages, estimated as long-run frequencies of the event of interest in relevant patient populations. These are factual statements based on empirical observations and as such are the only objective estimates of risk that can be presented to a patient without prejudice. The current recommendation that this be superseded by information based on patient’s subjective values that the clinicians have no clear way of estimating cannot be seen as an improvement. True patient autonomy is realised only when the patients are free to make their own decisions. Even if we were to accept people as rational agents, despite clear evidence to the contrary, a truly informed decision is only possible when the rational agents have access to complete and accurate information, neither of which are possible in clinical practice. We believe that informed consent, as applied in clinical practice, is a convenient compromise between ideology and pragmatism. Patient autonomy can also be in conflict with informed consent; if a patient makes a decision but declines any information regarding risk, can this truly be considered an informed consent? Finally, we also believe that paternalism has not been completely displaced by patient autonomy. It has merely changed its focus, with clinicians now required to exercise their discretion on subjective value systems, instead of risk thresholds and expert consensus. It is clear that a ‘one solution fits all’ approach is not suitable to the problem of consent. The current approach that places patient autonomy over everything else is effectively replacing one flawed solution with another. While we agree that it is a reflection of current social principles, we caution against considering it either as a panacea or a permanent solution.