Journal of the New Zealand Medical Association, 25-October-2002, Vol 115 No 1164
A colleague has sent me a copy of your recent paper1 (http://www.nzma.org.nz/ journal/115-1162/181/). I write to express praise and sympathy in equal measure.
I retired in 1988 after more than 20 years on the staff of Green Lane Hospital. Until then, we had been lucky in that nobody lectured us on our duty to provide relevant explanations to our patients. We just gave them as a natural part of our job, and I can’t recall any complaints. ‘Informed consent’ was discovered, in the Cartwright Report, as a considerable novelty; to us it was rather old hat. I had been keenly interested in medical ethics since 1960; I was a foundation member of the Green Lane Ethics Committees, one for patients and another for experimental animals, from 1973 until my retirement.
Following Cartwright, such ‘local’ committees were abolished. I thought it a big mistake. Beyond that, it seemed to me that several provisions of the Cartwright Report were ‘difficult to accept, insufficiently precise, or even contradictory’.2 For example: ‘The person seeking the patient’s consent must be satisfied that she can read and understand it’. Yet, five lines on: ‘It should never be assumed that the patient who appears to read and understand a form has in fact read and understood it’. Verbal explanations must surely court this very dilemma, but of course by then everything had to be written down as well, if only for our self-defence.
Then there was the question of what ‘informed’ meant. Arguably, consent can be admirably informed yet quite ignorant. I wrote about that.3 Franz Ingelfinger had said something about it too.4
But of course all this writing went for nothing! Cartwright, flawed or not, carried the day! I don’t want to discourage (far less depress!) you, but I fancy that you shouldn’t expect much. ‘There is a tide in the affairs of men, / Which, taken at the flood, leads on to fortune’. I obviously missed the tide. Seeing what’s become of us, I now think, despite a most rewarding professional life, that I should have read Physics instead. I should have needed good doctors, but then I do now anyway! I await Next Time Round with interest.
Do keep going!
Clinical Physiology Department, Green Lane Hospital
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