Warnings And Consent

Doctors have a professional duty to inform and to warn, so that patients, who are increasingly informed and educated, may make meaningful personal choices, which it is their right to do (unless they opt to leave the choice to the doctor, which it is also their right to do).

• Warnings that will affect the patient's choice to accept or reject the treatment

• Warnings that will affect the safety of the treatment once it has begun, e.g. risk of stopping treatment^ occurrence of drug toxicity.

Just as engineers say that the only safe aeroplane is the one that stays on the ground in still air on a disused airfield or in a locked hangar, so the only safe drug is one that stays in its original package. If drugs are not safe then plainly patients are entitled to be warned of their hazards, which should be explained to them, i.e. probability, nature and severity.

There is no formal legal or ethical obligation on doctors to warn all patients of all possible adverse consequences of treatment. It is their duty to adapt

PRESCRIBING, CONSUMPTION AND ECONOMICS

the information they give (not too little, and not so much as to cause confusion) so that the best interest of each patient is served. If there is a 'real' (say 1-2%) risk inherent in a procedure of some misfortune occurring, then doctors should warn patients of the possibility that the injury may occur, however well the treatment is performed. Doctors should take into account the personality of the patient, the likelihood of any misfortune arising and what warning was necessary for each particular patient's welfare.36

Doctors should consider what their particular individual patients would wish to know (i.e. would be likely to attach significance to) and not only what they think (paternalistically) that the patients ought to know. It is part of the professionalism of doctors to tell what is appropriate to the individual patient's interest. If things go wrong doctors must be prepared to defend what they did or, more important in the case of warnings, what they did not do, as being in their patient's best interest. Courts of law will look critically at doctors who seek to justify under-information by saying that they feared to confuse or frighten the patient (or that they left it to the patient to ask, as one doctor did). The increasing availability of patient information leaflets (PILs) prepared by the manufacturer indicates the increasing trend to give more information. Doctors should know what their patients have read (or not read, as is so often the case) when patients express dissatisfaction.

Evidence that extensive information on risks causes 'unnecessary' anxiety or frightens patients suggests that this is only a marginal issue and it does not justify a general policy of withholding of information.

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