Discussion
This study has examined patient satisfaction with the way that informed consent is
obtained from elective general surgical patients at Auckland Hospital. Three of the
four key components of the informed consent process1–3 have been examined and
there is room for improvement in each of them. These are: 1) the actual disclosure of
information about the nature of, risks associated with, and alternatives to treatment; 2)
whether the consent giver feels they understood the information; and 3) whether
consent was given freely. The fourth component regarding the competency of the
consent giver was not evaluated in this study. In 1994, the Health and Disability Act
established the patient’s legal right to informed consent by stating that “no health care
procedure shall be carried out without informed consent”.4 Subsequently, a Code of
Consumer Rights developed by the Health and Disability Commissioner was given
the status of law under the authority of the Act.4 Of particular relevance to this study
are Right 5 (the right to effective communication), Right 6 (the right to be fully
informed), and Right 7 (the right to make an informed choice and give informed
consent).
In law, there are three different recognised standards for determining the adequacy of
information disclosure. The first is the ‘professional standard’ (also known as the
Bolam’s test), which is determined by the practice of the majority of the profession.
The second is the ‘reasonable person’ standard (also known as the ‘objective
standard’), which is determined by what a reasonable or prudent person would
require. The third is the ‘subjective standard’, which is determined by what an
individual patient seeks.