Wouter Leclercq

A survey of the current practice of the informed consent process in general surgery in the Netherlands 43 3 BACKGROUND It is common surgical practice to provide patients with the opportunity to consent to an operative procedure. Moreover, a surgical informed consent process (SIC) is considered a conditional element of standard surgical patient care. The basic elements presupposed by the Nuremberg and Helsinki code, the U.S. National Institute of Health and the World Health Organization are ‘assessment of preconditions’, ‘provision of information’ and the ‘stage of consent’ (Figure 3.1). 1-4 A properly conducted SIC process is an interactive and structured process resulting in fully informed patients who are truly able to make an informed decision on risks and benefits of a treatment, alternative treatment options or postponing surgery. 1,5-7 Past, present and future aspects of SIC were discussed in a previous contribution. 1 Conversely, an inadequate SIC compromises patient autonomy, creates potential risks, diminishes patient satisfaction and trust in their surgeon and thereby jeopardizes the patient-physician relationship. Moreover, SIC violation may lead to a disciplinary tribunal, assault or battery action. 8,9 3. Stage of consent - Patient consenting to the surgical procedure - Recording of this authorization - Patient education - Recommendation of a care plan - Understanding of this information by the patient 2. Provision of information - Patient competence and voluntariness 1. Assessment of preconditions Figure 3.1 Three elements of informed consent. In the Netherlands, surgical patients are predominantly treated in 94 public hospitals around the country (8 university, 26 large teaching and 60 general hospitals). A limited number of private clinics (10%) provide a restricted volume of outpatient surgical care.