(Informed consent - the debate)
Informed Consent - a response to recent correspondence)
In this week's BMJ, Doyal reiterates his view (first stated in BMJ, vol.314 12 April 1997 p.1107-1111) that informed consent should be insisted upon with only a few narrow exceptions.
Contact:
Professor Len Doyal, Professor of Medical Ethics, St Bartholomew's and The Royal London Hospital School of Medicine and Dentistry
(Studies that do not have informed consent from participants should not be published)
In answer to the question "Should the BMJ reject all studies that do not include informed consent?", Goodare's simple answer is "Yes". She also notes that researchers ignore a valuable resource if they do not consult patients in designing their trials as "joint ownership of the work being done keeps patients involved instead of isolating them".
Contact:
Heather Goodare, Counsellor and Chair, Research Committee, UK Breat Cancer Coalition, Horsham, West Sussex
(Changing the BMJ's position on informed consent would be counterproductive)
Tobias argues that journals such as the BMJ should sometimes publish papers that do not include fully informed consent. He cites circumstances such as emergency medical situations when informed consent is impractical and asks what is the point of insisting upon fully informed consent when doing so is being "needlessly cruel". By drawing on several responses to his original article (BMJ vol.314, 12 april 1997, p.1111-4), Tobias concludes that the BMJ would be unwise to stifle important research by confining too closely the outline, structure and phraseology of trial consent and that such details are better left to the originators of studies and their local ethics committees.
Contact:
Jeffrey Tobias, Consultant in Radiotherapy and Oncology, Meyerstein Institute of Oncology, Middlesex Hospital, London
(Trial subjects must be fully involved in design and approval of trials)
To improve the practice of obtaining informed consent there must be a number of changes in attitudes, says Power in this week's BMJ. She suggests that there needs to be a greater emphasis on doctors' education in interpersonal and communications skills. She also feels that giving patients (or potential patients) some involvement in the design and approval of trials is a positive move and "not just a hoop to jump through".
Contact:
Lisa Power, Health Advocacy Manager, Terence Higgins Trust, London lisap@tht.org.uk