Informed consent: an empty promise? A comparative analysis between Italy and England, Wales, and Scotland
Research Article
Caterina Milo
Medical Law International, 16 June 2022
Open Access
Abstract
Informed consent (IC), as the process of sharing information between patients and clinicians before undertaking a medical treatment, signals a number of ‘good intentions’. IC, in its theoretical formulation, can be seen as valuing the expertise and contributions of both clinicians and patients, giving expression to the aspirations of both promoting patient autonomy and facilitating doctors to work in partnership with their patients. The Supreme Court judgement in Montgomery v Lanarkshire Health Board1 and the Italian legislation on IC2 are, in this respect, worthy of analysis as both provide valid examples of these ‘good intentions’. However, the reality of how IC has been translated in courtrooms does not always match the expectations. This article, through a comparative reflection, will claim that a gap between the ‘law in theory’ and the ‘law in practice’ is common to both legal systems. The article ultimately claims that changes in both legal and policy approach are needed in order to better safeguard IC.

Clinical adolescent decision-making: parental perspectives on confidentiality and consent in Belgium and The Netherlands
Research Article
Jana Vanwymelbeke, David De Coninck, Koen Matthijs, Karla Van Leeuwen, Steven Lierman, Ingrid Boone, Peter de Winter, Jaan Toelen
Ethics & Behavior, 15 June 2022
Abstract
This study investigated Belgian and Dutch parental opinions on confidentiality and consent regarding medical decisions about adolescents. Through an online survey, we presented six cases (three on confidentiality, and three on consent) to 1,382 Belgian and Dutch parents. We studied patterns in parental confidentiality and consent preferences across and between cases through binomial logistic regressions and latent class analysis. Participants often grant the right to consent for a treatment to the adolescent, but the majority diverges from the adolescent’s preferences regarding confidentiality. More educated participants would rather not be informed about cases regarding a sexually transmitted disease or depression than lower educated participants. Further analysis shows that participants’ preferences correspond to authoritative (47%), permissive (30%) and authoritarian (17%) parenting styles. Belgian and Dutch parents are willing to grant some degree of autonomy, but they want to be informed about specific health issues. Parental views on confidentiality and granting consent appear to mirror existing parenting styles.

Evaluating Knowledge, Practice, and Barriers to Informed Consent Among Professional and Staff Nurses in South Africa: An Empirical Study
Sylvester C. Chima
Canadian Journal of Bioethics, 13 June 2022; 5(2) pp 44-70
Abstract
Background
Informed consent (IC) is an ethical and legal obligation protected by constitutional rights to bodily integrity, well-being, and privacy in South Africa. The National Health Act 2003 codified IC regulations, requiring that all healthcare professionals inform patients about diagnosis, risks, benefits, options, and refusal rights while factoring in patients’ language and literacy levels.
Objectives
This study’s primary aim was to determine the extent of South African professional/staff nurses’ compliance with current IC regulations and ascertain socio-cultural impediments impacting proper IC practice.
Methods
A cross-sectional survey using semi-structured questionnaires was used to evaluate knowledge and practice of IC among nurses in KwaZulu-Natal province. Data were analyzed using SPSS, v.21. Descriptive statistics, chi-squared tests, and content analysis were used to compare nursing domains.
Results
Three hundred fifty-five (355) nurses, 92% females, with 1 to 41 years of professional experience, completed this study. Information disclosed by nurses to patients included diagnosis (77%), treatment benefits (71%), risks (69%), recommendations (65%), risks of refusal (80%), and right of refusal (67%). Nurses (80%) felt information disclosure was adequate, while 85% reported that patients understood disclosed information.
Conclusions
Nurses practicing in local public hospitals had moderate knowledge of IC regulations. Practical implementation appeared deficient. Barriers to IC included language, workload, time constraints, lack of interpreters, and skewed gender norms in the nursing profession. Nurses require continuing professional education in healthcare law and ethics, a “corps of trained interpreters”, and gender transformation in the nursing profession to improve IC practice and overall quality of healthcare service delivery in South Africa.

Informed Consent: The Surgical Patient’s Experience in a Tertiary Hospital in Northwest Nigeria
B A Grema, S T Tanimu, G C Michael, I Aliyu, S A Aji, I U Takai, A I Sulaiman
West African Journal of Medicine, 27 May 2022; 5 pp 471-478
Abstract
Background
Obtaining informed consent (IC) before a surgical procedure is the cornerstone of medical practice. The practice of IC continues to evolve as litigations increase. Most studies on patients’ perspectives of IC are either old or were done in southern Nigeria. This study assessed the surgical patients’ IC experience in a tertiary hospital in northwest Nigeria.
Methods
This cross-sectional study assessed 244 consecutive patients who had elective surgeries in surgical departments of a tertiary hospital. Pretested questionnaires were used to collect data regarding their perception of the meaning of IC, the process of obtaining it, satisfaction with how it was obtained, and factors associated with satisfaction on how consent was obtained.
Results
Most were females (61.9%); their mean age was 34.8±14.3 years; 52.9% and 61.9% of respondents did not believe that IC enables patient-clinician shared decision-making or patient’s self-decision making, respectively. Most were allowed to ask questions (83.2%), received information on the surgical procedure (91.4%), diagnosis (97.9%); however, 38.5% and 48.8% did not receive information about surgical procedures’ immediate and long-term complications, respectively. Surgical procedure explanation was mostly provided by Resident Doctors (53.7%). Most (88.9%) were satisfied with how IC was obtained; satisfaction was associated with being allowed to ask questions, receiving explanations on diagnosis, surgical-procedure, complications of surgery, available alternative treatments, and when the resident/ consultants gave the explanation (all P<0.05).
Conclusion
Deficiencies exist in the process of getting IC. Satisfaction with this process was high though associated with following the recommended strategies. Improving the IC process will require appropriate interventions in this and similar settings.

The Doctrine of Patient’s Informed Consent in the Legislation and Jurisprudence of Czech Republic and the Latvian Republic
Urkevich Tatjana Ivanivna, Anatoliy Anatoliyovych Lytvynenko
Medicne parvo, 2022; 1(29) pp 49-94
Abstract
The article represents the history, emergence and the contemporary state of development of the legal doctrine of the patient’s informed consent to medical interventions in Czech Republic, Austria and the Latvian Republic. The authors focus on the vaults of the doctrine of the doctor’s obligation to abstain from conducting any medical interventions without the consent, or against the will of the patient, since the expression of the patient’s will is the central element of his right to self-determination. In order to discover the main features of informed consent in the civil law perspective, the authors discuss the historical and current legal developments of the legal institute of patient’s informed consent. The authors conclude that the formation of the institute owes to the right to body integrity and limitation of the exercise of medical profession by practitioners, and that the civil law doctrine of informed consent differs from Anglo-American tort law, relying on statutory-based civil liability for negligence, as well as minor penal liability for battery, an occasional interpretation of unauthorized medical intervention. The authors emphasize, that the existing bodies of Austrian, Czech and Latvian case law relating to informed consent, which span for over a century, are sufficient to become a branch of Continental medical malpractice case law alongside with aged and well-developed French or Belgian medical jurisprudence, whereas the Latvian medical jurisprudence, despite having a rich history of emergence since the 1920s, has developed a solid body of case law in regard with patient’s rights relatively recently.

Editor’s note: Medicne pravo is published by the Danylo Halytskyi Lviv National Medical University.

Ethical obligation and legal requirements: On informed consent practices in Bangladesh
Original Article
Sonia Mannan, Jobair Alam, K. M. Ashbarul Bari, S. M. A. A. Mamun, Rehnuma Mehzabin Orin
Developing World Bioethics, 19 May 2022
Abstract
Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in Bangladesh and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care.

Understanding of Critical Elements of Informed Consent in Genomic Research: A Case of a Paediatric HIV-TB Research Project in Uganda
Research Article
Francis Anyaka Amayoa, Frederick Nelson Nakwagala, John Barugahare, Ian Guyton Munabi, Erisa Sabakaki Mwaka
Journal of Empirical Research on Human Research Ethics, 12 May 2022
Abstract
Several studies have reported inadequate comprehension of informed consent for genomic research. This study aimed to assess research participants’ understanding of critical elements of informed consent for genomic research. A cross-sectional survey involving 123 parents/caregivers of children participating in a paediatric genomic TB/HIV study was conducted. Only 47.2% of the participants had adequate understanding of consent information. The mean objective (actual) and subjective (perceived) understanding scores were 78.7% and 91.7% respectively. Participants adequately understood most elements of consent however, some elements were poorly understood including foreseeable risks, protection of confidentiality and compensation for research related injury. Overall there was inadequate comprehension of critical elements of informed consent and there was dissonance between actual and perceived comprehension of informed consent.

Awareness of Knowledge, Attitude and Practices of Medical Students and Surgical Trainees Regarding Surgical Informed Consent: A Cross-sectional Multicentric Study from Northern India
Nishtha Singh, Sudhir Kumar Jain, Tariq Hameed, Kanwal Preet Kochhar, Param Jit, Chandra Bhushan Singh
Asian Journal of Medicine and Health, 22 March 2022; 20(3) pp 25-31
Open Access
Abstract
Background
Informed Consent is the cornerstone of modern medical and surgical care. All patients have the right to be involved in decisions about their treatment and care. Obtaining SIC (surgical informed consent) is an important and essential skill that one must acquire in medical training, yet many residents receive very little formal education.
Methods
Multiple choice questionnaire designed and after pretesting circulated on Google formsTM having questions pertaining to knowledge, attitude and practice. Total 463 responses obtained and appropriate statistical tests applied in Microsoft Excel and StataSE.
Result
Knowledge-score remained constant for medical students and trainees, Attitude-score (18.59 to 18.93) and Practice-score (2.30 to 3.62) statistically significant increase in score with clinical exposure was noted. Gender wise difference were in A-score, females scored higher 18.87 and males scored 18.49. For trainee doctors unlike P scores, K and A scores did not increase with experience.
Discussion
Early intervention in undergraduate years and continuous upskilling is the need tobridge the hiatus of doctor-patient relationship. This necessitates scenario and role play based teaching, student teaching patient based learning regarding the SIC.
Conclusion
There is a Knowledge attitude practice gap present not only in undergraduate students but postgraduates residents regarding SIC, for which the current curriculum and the ongoing practical training is insufficient to bridge. Indian curriculum must make amendments to bridge it.

Tips for Managing Ethical Challenges in Advance Care Planning: A Qualitative Analysis of Japanese Practical Textbooks for Clinicians
Article
Environmental Research and Public Health, 9 April 2022
Yoshihisa Hirakawa, Kaoruko Aita, Mitsunori Nishikawa, Hidenori Arai, Hisayuki Miura
Abstract
Background
While advance care planning (ACP) provides healthcare professionals with valuable tools to meet patients’ needs in a person-centered manner, several potential ethical challenges are inherent to the process. However, recent studies have largely focused on ACP practicalities such as implementation, execution, and completion rather than on the ethical challenges that clinicians routinely encounter in ACP practices.
Research question/aim/objectives
This study aimed to identify tips for clinicians managing ethical challenges in ACP practices.
Methods
It performed a brief search for all Japanese published books pertaining to ACP practice available as of January 2021 using the keywords “advance care planning (ACP)” and “autonomy” and analyze the content of nine practical ACP textbooks for clinicians.
Results
Two major themes capturing the essential recommendations for managing ethical challenges in ACP were ultimately identified, namely interprofessional ethics and informed consent.
Conclusion
The findings suggested tips for managing ethical challenges in ACP: refer to ethical frameworks for interprofessional collaboration and ethical decision making, assess decision-making capacity of family substitute decision makers and one’s eligibility for the role, understand the standard process of informed consent and how to handle situations when the patient are not well informed about the diagnosis and prognosis of non-cancer illness.

Study about Informed Consent for Surgical Care in East Africa
Richard Wismayer
New Horizons in Medicine and Medical Research, 6 April 2022; 3 pp 210-215
Abstract
In the developed world, informed surgical consent is one of the pillars of ethical conduct in surgical practise. Only a few researchers in low-income developing countries have investigated the practise of pre-operative surgical consent. During the informed consent process, the patient has the right to make an autonomous and independent decision about his or her surgical treatment after the surgeon caring for the patient has provided the necessary information. The World Medical Association (WMA) Declaration of Lisbon encourages patient autonomy and independent decision-making. Informed consent in surgical practise may be influenced by factors such as family and cultural background, education, religion, and socioeconomic status. Few studies have reviewed consent practises among surgeons in East Africa to document best surgical practises and identify areas for improvement in the East African setting. The purpose of this review was to report on the authors’ personal experiences with surgical consent among Ugandan surgeons, as well as to discuss the specific challenges faced in East Africa. In Uganda, informed consent administration and documentation remain deficient. In medical schools, better medical ethics education and communication skills training are required. For fully trained surgeons, refresher courses in medical ethics and communication skills may also be required.