Few patients have more than the barest understanding of how their bodies work, Their assumptions for treatment are based on a desire for health and on a conditioned respect for a doctor's care. A consultant's intentions are affected by such diverse constraints as funding, priorities in patient care, training needs, or a personal desire to try out a new technique. Such an ill-matched pairing can turn "informed consent" into "misguided compliance". For example, a person may agree to an operation believing his consultant will look after him, and never know that not he, but a subordinate, operated.
Informed consent is the name for the general principle of law which states that a physician in a non-emergency situation has an obligation to inform a patient of the risks, benefits and alternatives which a reasonably prudent patient would have considered material to his decision whether or not to undergo a proposed treatment. The information should be honest, clear and comprehensible, and appropriate to the patient's condition and personality. Thus informed consent is a two-stage process: (1) informing the patient of the nature, objectives, constraints and know risks of the proposed treatment; and (2) the free decision of this person to undergo a surgical or medical treatment or to accept to take part in a research procedure.
Various laws regulate the physician/patient relationship such as the Nuremberg Code (1947) and recommendations adopted by the World Medical guiding physicians in biomedical research involving human subjects, e.g. "In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort it may entail. He or she is at liberty to abstain from participation int he study and he or she is agree to withdraw his or her consent to participation at any time. The physician should then obtain the subject's freely-given informed consent, preferably in writing." (adopted September 1989).
In 1993, it was reported that thousands of anaesthetized women awaiting operations in teaching hospitals in the UK had been unknowingly used as subjects for gynaecological students. Of the 17 of 29 UK medical schools which responded to a survey in 1991, 6 required written consent for a vaginal examination, 8 told medical students to get the patient's verbal consent (but had no inbuilt monitoring procedures that this was done), and 3 had no formal system of obtaining informed consent.
Asking for a patient's consent before an operation is a charade. People are not always given full information about their illness or about possible alternative treatments, and surgeons pay to little attention to the sensitivities of patients. As a group they place restriction and constraints on good practices like randomized control trials in which to test surgical procedures, and yet allow unrestrained innovative surgery.