Informed consent for elective surgery--what is best practice?

Increasing medico-legal litigation,1 and the desire to provide patients with more say concerning their own treatment, has highlighted the issue of informed consent and how it is obtained. In order for a patient to make a sensible decision concerning his or her treatment they need appropriate information. This may occur via discussions with medical/nursing staff, via the media/internet, or from speaking with friends who have undergone a similar procedure. However, it chiefly occurs during the acquisition of informed consent, during which the risks and benefits of any surgical procedure are explained. The principles of this paper are applicable to consent for any elective surgical procedure. However, we highlight examples from phacoemulsification cataract surgery, the most widely performed elective ophthalmic operation. This is an ideal example of elective surgery, as it can be performed with an equal outcome both early and late in the natural history of cataract, with the timing of surgery heavily reliant upon the patient's visual demands, anxieties and expectations. The discussion is focused predominately on UK Department of Health guidelines and English law, but many of the underlying ethical principles are still applicable to patients overseas.