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Essex County Hospital, Lexden Road, Colchester CO3 3NB, UK; drgmsaleh@yahoo.co.uk
Accepted for publication 12 May 2003
Keywords: consent; blindness; visually
It is a general legal and ethical principle that valid consent must be obtained before starting treatment or physical investigation of a patient. The validity of consent does not depend on the form in which it is given (verbal or written), rather it depends on it being given voluntarily by an appropriately informed person who has the capacity to consent to the intervention in question. Written consent merely serves as evidence of consent. There is no English statute setting out the general principles of consent, rather it is set by precedent or case law ("common law"). Hence, in visually impaired people (VIPs), instead of written consent should we not have moved to a better alternative—recorded audio consent (RAC)—legally equivalent as a record of consent but practically superior as a method? There are many good reasons why we should.
Firstly, health professionals are required to take all reasonable steps to facilitate communication with the patient, using interpreters or communication aids as appropriate.1 The Department of Health has issued guidance on communication with patients who have sensory disabilities.2 For those who cannot see, RAC would be more in line with these guidelines and recommendations than written consent.
Secondly, the problems with vision are frequently compounded by poor hand-eye coordination and manual dexterity especially as most VIPs (2.4 million in England and Wales) are over 65 years old.3 RAC would overcome the problems in these circumstances. Further, as many procedures VIPs have are not eye related and the consenting practitioner non-eye trained (therefore not used to dealing with VIPs and their difficulties), non-ophthalmic units would also benefit from this technique.
Thirdly, we speak faster than we write and in any event the whole process needs to be undertaken verbally in the first instance. RAC would be a time saving exercise.
Fourthly, ever advancing current technologies allow for large volumes of audio recording in a more space efficient manner than cumbersome written consent. These devices (digital recorders, dictaphones, and others) are now available on the mass market at relatively low cost or already present within the health services.
Fifthly, section 21 of the Disability Discrimination Act4 states that service providers are obliged to take reasonable steps to change practices, policies, or procedures which make it impossible or unreasonably difficult for a disabled person to use a service. As from 2004 steps will have to be taken to remove difficulties altogether. RAC works strongly in conjunction with this act.
Finally, a practitioner trying to convince an opposing party that a blind person had been able to read the form they signed, thus providing evidence of informed consent, would certainly find it more difficult to prove than if the whole consent process had been recorded with RAC.
RAC would thus benefit patients and practitioners alike, facilitating consent and making it a more robust process in the United Kingdom and other countries alike.
References
Department of Health. Guidance for consent. London: DoH, (www.doh.gov.uk/consent).
Department of Health. Circulars HSC 1999/093 and HSC 1999/156. London: DoH,.
The Royal College of Ophthalmology. Epidemiology of eye disease in the older population, 2.2.1 Visual Impairment and its causes. London: RCO.
Disability Discrimination Act 1995:c 53, Pt III, s 21.