Informed consent to elective surgery: the 'therapeutic' value?

The prospect of surgery represents a threatening and often fear-provoking event even to adult patients. Medical practitioners are responsible for obtaining informed consent for elective surgery, which includes an explanation of the reasons for surgery and its likely and possible effects. In practice a dilemma exists between the principle of respect for autonomy of the patient, and between the wish to do the patient no harm. The extent to which patients have been shown to benefit or to be harmed by information about elective surgery is examined by reference to existing studies of surgical patients and to the author's data gathered for interviews and observations on two samples of 131 and 80 women undergoing minor gynaecological surgery. The evidence suggests that most adult patients wish to be informed in detail about their surgery. Information about the likely serious complications is upsetting to some patients, but accurate information about the likely effects of surgery is welcomed, and may even promote faster recovery after the operation. However, much information presented to patients is not understood or is rapidly forgotten. Greater involvement by patients in discussions about their medical care may redress some of these problems and shift some of the responsibility towards the patient.