Guidelines on informed consent in anaesthesia: unrealistic, unethical, untenable….

'Informed consent' has become the primary paradigm for protecting the legal rights of patients and guiding the ethical practice of medicine.¹ The Association of Anaesthetists of Great Britain and Ireland (AAGBI) 'informed consent' guidelines have recently been updated in response to 'the changing ethical and legal background against which anaesthetists, intensivists and pain specialists, currently work'.² This guidance aims to advise its members (and others) how to provide information about anaesthesia that respects patient autonomy and stays within the law.³ This raises the question, are we really achieving the key principles of primum non nocere,⁴ respect for patient autonomy,⁵ and the need to provide adequate information?⁶ Current guidance has been almost solely based on medicolegal determinations around inadequate informed consent, focusing on the failure to disclose a 'material risk'.⁷⁸ This has led health authorities and many clinicians to interpret the guidelines as a directive, informing patients of an ever-increasing list of potential anaesthesia-related adverse events. Misguided attempts to include every possible 'material risk' are leaving patients bombarded with excessive amounts of largely irrelevant and incomprehensible information.⁹¹⁰ This practice is also leading to unnecessary alarm and confusion, not to mention exposure of patients to the adverse effects of nocebo communications (negative suggestion).¹¹

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