Informed Consent - The Trojan Horse of Western Medicine

When a doctor does anything to you he enters into a contract. That contract prevents him for being sued for assault or battery. To keep his side of the contract the doctor has a legal duty to inform you of the risks and benefits of any procedure.

Exactly what he needs to inform you about is somewhat grey. The standard of care in the past has been the Bolam test. This test case from the 1950's established that:

If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent
— Bolam vs Friern 1957

In other words, so long as other doctors agreed with what you did, then you were in the clear.

The Bolam test was the accepted benchmark for treatment and consent for over 50 years. Then, in 2015, a test-case was bought by a woman who had not been warned of the risks of problems in her pregnancy. She won the case and the subsequent legal advise regarding consent was that doctors need to take...

...reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.
— Montgomery vs Lanarkshire Health Board 2015

In other words it is no longer enough to say that a 'reasonable' doctor would have done the same: rather what a reasonable patient would expect to know.

This is a huge change in how doctors should practice. In the past it was enough to simply wheel out some venerable old fellows to say that (for instance with the Bolam case) you don't need to give muscle relaxants during ECT. Now, you need to tell the patient that without muscle relaxants they might break bones and injure themselves!

So lets look at some common practices that doctors still do (muscle relaxants are now accepted as good practice in ECT...)

  • Flu vaccines

By definition no doctor can know whether a flu vaccine is going to work (because when they make the vaccine it is for next years flu). True informed consent should include a statement such as this prior to injection:

'there is some evidence that flu vaccines can prevent serious illness in susceptible people with COPD, however we do not know if this vaccine will work. Furthermore there is evidence now that vaccination may make you more susceptible to severe flu in the future. Vaccines are associated with adverse reactions including new chronic diseases. '
  • CT scans.

There are now two reputable sources that independently assess that CT scans have a 1 in 1000 risk of fatal cancer. It is undeniable that most patients would want to know this risk to make an informed decision so CT scans should include consent such as this:

'I'd like to perform a CT scan to evaluate your condition further. The current evidence suggests that CT scans carry a 1 in 1000 risk of fatal cancer. On this occasion I believe the risk of not doing a CT scan outweighs the risk of cancer.'
  • Breast Cancer Screening

Breast cancer screening has failed so comprehensively to reduce breast cancer deaths that even the original professor who set up the scheme believes it should be stopped. Proper consent for breast cancer screening should include something like this:

'We would like to do some tests including xrays and ultrasound. Xrays can cause breast cancer. The best evidence shows that there is little to no reduction in overall mortality or breast cancer mortality from screening. There is a chance that you may be subjected to unnecessary medical procedures, surgery and even mastectomy.

...and so on and so on.

When we start to put Western medicine under the kind of evaluatory microscope that 'quack-busters' are so keen to put alternative medicine under, we come to a radical new understanding of medicine itself. This takes us to a place where acupuncture and other forms of ancient medicine naturally come to the forefront as inherently safe, cheap and effective.

Informed consent gives us the legal tools to show that not only is Western medicine often dangerous, it is also often practiced recklessly and arguable illegally.


daniel keown2 Comments