Samuels: Informed Consent: The Law 35

Informed Consent: the law A SAMUELS JP Barrister BA(Cantab) Formerly Member of the Council of the British Academy of Forensic Sciences and of the Medico-Legal Society

Informed consent. What is the law as it now stands? The definitive statement is to be found in Sidaway vBoard of Governors of the Bethlem Royal Hospital and the Maudsley Hospital [1985] A.C. 871.

THE FUNDAMENTAL PROPOSITIONS 1. What the doctor discloses to the patient and what he does not disclose is a matter of clinical judgment for the doctor. 2. The doctor is entitled to follow the contem­ porary accepted practice, or practices, of competent responsible doctors. 3. The doctor is entitled to choose to follow one of two or more accepted practices, including a minority practice. 4. There is no duty to warn of the inherent risks in proposed treatment. 5. There may be such a substantial and obvious risk of grave consequences that the prudent doctor is obliged to inform the patient (any medical practice notwithstanding). 6. The less likely the risk of harm the less likely there is to be a duty to inform. Though the greater the likely harm in the event of the small risk materializing is a factor to consider. Thus the risk may be say one to two per cent; the consequences could be mild or catastrophic, or anything on that spectrum. 7. Where the patient specifically asks to be informed then the doctor must make disclo­ sure. 8. The reason why the law requires disclosure when it does so require is that the disclosure would or might influence the patient in decid­ ing whether or not to consent to undergo the treatment.

9. The overriding consideration guiding the doctor must always be the best interests of the patient. 10. Informed consent means a full and genuine understanding of the nature, purpose and like­ ly effects of the treatment.

DIAGNOSIS AND TREATMENT The duty of care to the patient is measured by the standard of the ordinary skilled man exer­ cising and professing to have that skill (Bolam v Friern Hospital Management Committee [1957] 1 W.L.R. 582, 586. Whitehouse v Jordan L1981] 1 W.L.R. 246, 258. Maynard v West Mid­ lands Regional Health Authority [1984] 1 W.L.R. 634, 638). The doctor should only undertake medical work for which he is properly trained, qualified, experienced and competent. He may be a general practitioner, or a young hospital doctor, or a consultant in a particular specialty.

DIFFERING OPINIONS There is ample scope for genuine differences of opinion. There is no breach of duty on the part of the doctor because he differs from his medi­ cal colleagues. The question is simply whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary professional care: Sida­ way 897B. Medicine is advancing all the time. It is not stagnant. New treatments are constantly emerging so there are often likely to be alterna­ tives available to the doctor, upon the efficacy of which opinions differ: Sidaway 892, 893. 'It is not enough to show that there is a body of competent professional opinion which con-

36 Med. Sci. Law (1992) Vol. 32, No. 1

siders that there was a wrong decision, if there also exists a body of professional opinion, equally competent, which supports the deci­ sion as reasonable in the circumstances. It is not enough to show that subsequent events show that the operation need never have been performed, if at the time the decision to operate was taken it was reasonable in the sense that a responsible body of medical opinion would have accepted it as proper' Maynard v West Midlands Regional Health Authority [1984] 1 W.L R. 634, H.L. See also Gold v Haringey Health Authority [1988] Q.B. 481, C.A.

PATIENT AUTONOMY The conscious adult patient of sound mind is entitled to decide for himself whether or not he will consent to submit to a proposed course of treatment, particularly where surgical treat­ ment under general anaesthesia is concerned: Sidaway 897D. There is no place for medical paternalism, i.e. 'the doctor always knows best'.

Inherent Every operation carries some risk. Risk is in­ herent. It may be nerve damage, paralysis, cardiac arrest, haemorrhage, infection, sepsis, it depends. The more serious the operation the greater the risk, although this is not invariably so. The patient knows that there is risk. He knows the ordinary and obvious risks. The more serious the operation the greater the duty of the doctor to discuss things with the patient.

Something special If there is something special in the risk because of its nature or magnitude, which is, or is likely to be, unknown to the patient, and knowledge of which would influence him in deciding whether or not to have the operation, then dis­ closure is called for. A general explanation would not be sufficient. The explanation must be such as fully to alert the patient to the risk.

Practice to mention The practice of the medical profession is very relevant. Is it the practice in such a situation to make express mention of this risk or danger? Or is it the practice of some doctors, reputable doctors, though not all? If express mention is required, to what extent, in what detail, is the

practice? Was the risk sufficiently disclosed, in general terms, albeit perhaps not in every de­ tail? Did the doctor explain the advantages and disadvantages of the operation, so that the pa­ tient was sufficiently informed so as to make up his own mind? 'A doctor offers a patient diagnosis, advice and treatment. The objectives, sometimes conflict­ ing, sometimes unattainable, of the doctor's services are the prolongation of life, the resto­ ration of the patient to full physical and mental health and the alleviation of pain. Where there are dangers that treatment may produce re­ sults, direct or indirect, which are harmful to the patient, those dangers must be weighed by the doctor before he recommends the treat­ ment. The patient is entitled to consider and reject the recommended treatment and for that purpose to understand the doctor's advice and the possibility of harm resulting from the treatment.' Sidaway 903H

Quality of information Overwhelming the patient with information, or 'blinding him with science', would be entirely counterproductive. The patient is a layman, not knowledgeable in medicine in professional terms, with limited capacity for absorption and understanding. Technical detail would only confuse him. The doctor must give the patient sufficient information, of the appropriate quality, to enable the patient to make an in­ formed and balanced judgment and decision: Sidaway. For Canada, see Haughian v Paine (1987) 4 W.W.R. 97.

Scared In the nature of things the patient is likely to be concerned, anxious, worried, scared. His character, personality, intelligence, experience, prejudices, fears, whatever, will be such that he can only take in so much, he can cope only with so much. It would not be sensible unduly to alarm him, in respect of a real but remote risk. Unnecessary alarm may make the operation itself and recovery more difficult; or even in­ duce the patient not to have the operation when all the indications were that it would be hugely desirable to have it.

Samuels: Informed Consent: The Law 37

CLINICAL JUDGMENT So the right to know is not overriding. The doctor decides what the patient shall know. The doctor exercises his clinical judgment. But that clinical judgment must be exercised with pro­ fessional skill and care, in the light of the accepted principles.

Best interests of the patient The over-riding duty of the doctor is always to consider the best interests of the patient. There must be nothing said or done which could be harmful to the patient. There is a duty to dis­ close special risks, so as to enable the patient to make a balanced judgment and to give, or with­ hold, informed consent, but only insofar as this would not be harmful to the patient or contrary to his best interests. Too much information, or badly presented information, or wrong infor­ mation, may prejudice not benefit the patient. The doctor has to make a sort o f balancing judgment: Sidaway 904B-905C. The judge is not there to substitute his opinion for that of the doctor. The judge is there to determine whether or not, as a matter of law, the doctor fulfilled his legal duty: Sidaway 895B.

Best interests to tell him, or to have the operation? The operation would be in the best interests of the patient. That is the bona fide professional judgment of the doctor. There are risks, prime facie calling for disclosure. If the doctor believes that disclosure would unduly alarm the pa­ tient, he is acting properly. If the doctor believes that disclosure will induce the patient to refuse the operation, irrationally, and so does not disclose, the doctor is acting improperly. He is seeking to impose medical dictatorship over patient autonomy.

Judge overrides the doctor The doctor did not disclose. He acted profes­ sionally, in all good faith. He followed contemporary medical practice. All the leading doctors say he did right. No doctor disagrees. Nonetheless it is still open to the judge to say that objectively, despite good faith, professional standards and universal practice, the risk was

so obvious and so serious that objectively, as a matter of law, no doctor could be other than legally at fault, legally negligent, in failing to make disclosure. It is difficult to conceive of such circumstances, and none appear to have fallen for judicial decision.

Asked The cases have turned on whether or not the doctor should volunteer information. When questioned specifically by a patient of appar­ ently sound mind about the risks involved in a particular treatment the doctor must answer, both truthfully and as fully as the patient re­ quires: Sidaway 898B. Presumably the doctor could properly say: 'I advise you not to ask me that question.' 'I advise you not to press that question.' 'I decline to answer.' 'I decline to answer, and suggest you seek the opinion of another doctor.' 'I am willing to answer the question if asked by your spouse, but not by you.' If he does ask, the patient should not have to ask in vain. But even if the patient does ask, e.g., about the side effects of a contraceptive drug, the duty to answer truthfully and fully still depends upon the circumstances, the nature of the enquiry, the nature of the information, its reliability and its relevance. Not all the infor­ mation available has to be disclosed, only a reasonable amount in the circumstances. The clinical judgment principle still applies: Blyth v Bloomsbuty Health Authority, The Times 11 February 1987, C.A. So even a 'white lie' might be lawful and sufficient in a proper case.

Don't tell me 'Don't tell me doctor, you do what you think is necessary.' The patient is saying, 'I do not wish to be informed, even if you would otherwise do so.' The patient is waiving his right to know. Lawful. Doctor protected. Though the doctor may well not wish to accept such responsibility. And the waiver should be made in writing and absolutely explicit, otherwise there could be the opportunity for misunderstanding.

38 Med. Sci. Law (1992) Vol. 32, No. 1

Disclosure to relative Disclosure by the doctor to the nearest and dearest, the spouse or nearest relative, is not a sufficient discharge of the duty, unless express or clearly implied instructions have been given to the doctor by the patient. Would have consented anyway The information and warning was not given as it should have been given. But the patient would have given consent anyway. (This may well be in issue, and the patient is quite likely to assert that he would not have given per­ mission, and after the event it is naturally not easy for the judge to decide — but assume the finding by the judge that the patient would have consented.) Although the patient cannot recover damages for the consequences of the operation, e.g. tetraplegia, he may recover damages for shock and depression at discover­ ing the consequences without prior warning: Lancet, 1 July 1989 57 Hutchison J. Therapeutic and non-therapeutic So far as the duty of care and the duty of disclo­ sure go, there is no distinction to be drawn between therapeutic and non-therapeutic treatment. The doctor advising on sterilization, or plastic or cosmetic surgery, or diet in a seem­ ingly fit patient, must still consider the risks and the extent to which, if at all, in the best interests of the patient they should be dis­ closed: Gold v Haringey Health Authority [1988] Q.B. 481, C.A — failure of sterilization. The risk o f failure of sterilization may not be very high, but the consequences for unsuspect­ ing parties can be very significant. Examples Laminectomy of vertebra. Risk, 1-2 per cent, of damage to spinal cord and nerve root. Risk not disclosed. Risk materialized, severe disable­ ment. No duty to disclose: Sidaway v Board of Governors of the Bethlem Hospital and the Maudsley Hospital [1985] A.C. 871. Doctor advised brain operation to avoid a threatened stroke: 4 per cent chance of death, 10 per cent chance of precipitation of threatened stroke. No disclosure. Risk materialized. Doctor negligent: Reibl v Hughes

(1980) 114 D.L.R. (3d) 1, Canada, approved in Sidaway (supra). Doctor did not advise patient of the risks involved in electric shock treatment. Doctor not in breach of duty: Bolam v Friern Hospital Management Committee [1957] 1 W.L.R. 582, approved in Sidaway (supra). Risk of failure in sterilization half of one per cent or less. No duty to disclose: Gold v Harin­ gey Health Authority [1988] Q.B. 481, C.A. Worster v City and Hackney Health Authority, The Times 22 June 1987, Garland J. Doctor did not warn patient that vasectomy might not be one hundred per cent, there might be a recanalization of the vas and renewed fertility. The risk materialized. The risk should have been disclosed: Thake v Maurice [1986] Q.B. 644, 679-680 C.A. — ad­ mission of negligence by doctor. Hospital staff Ultimate clinical responsibility rests with the doctor. Ultimate management responsibility rests with the hospital authority, e.g., selection and supervision of staff, provision of plant and equipment. But the individual liability may also fall upon hospital staff, e.g., junior doctor, nurse, technician, whoever. A member of the staff concerned with the provision of blood for blood transfusion may be asked by a patient about the risk of HIV: Lee v South West Thames Regional Health Authority [1985] 1 W.L.R. 845, C.A. INFORMED CONSENT Informed consent presupposes a full and ge­ nuine understanding of the nature, purpose and likely effects of the proposed treatment. An apparent consent may be vitiated. The patient may be ill, anxious, racked by pain, volunteer in order (as he sees it) to gain quick relief from pain, or priority treatment, or (in the case of a prisoner) earlier release from compulsory detention (e.g., chemically castrating drugs for sex offenders — Daily Telegraph, 18 December 1989). Minors, mentally incapable Where the patient is unable himself to give consent, because of age, or mentally incapable,

Samuels: Informed Consent: The Law

then the parent or guardian or other legally responsible person must act on behalf o f the patient, and ultimately the judge, acting in the best interests of the patient: B (A Minor) (Wardship: Sterilisation) [1988] A C . 199 — mentally handicapped girl o f 17. F (Mental Pa­ tient: Sterilisation) [1990] 2 A.C.I H.L. — mentally handicapped woman of 36. As a mat­ ter of good practice it is highly desirable that consent should be obtained from the judge F (supra). C, The Times 13 February 1990. M (A Minor) (Wardship: Sterilisation [1988] 2 F.L.R. 497. Gillick [1986] A.C. 112. C (A Minor) (Wardship: Medical Treatment) [1990] Fam. 26, C.A. A child under 16 may nonetheless be suffi­ ciently mature to be able to give de facto consent: Gillick [1986] A.C. 112. A child may be made subject to the court or the local authority, and lawful consent may be given by the court or the local authority. The unconscious patient manifestly cannot give consent. There may be express or implied consent; otherwise strictly there is a technical battery, and no defence of necessity. Damages would be nominal, unless the doctor had acted against the known wishes of the patient, e.g., a known Jehovah's Witness, or known to be car­ rying a forbidding card: Malette v Shulman (1988) 47 D.L.R. 18, Canada. Incidentally, where liability does arise the cause of action may lie in battery and in negligence, and it may be that an act done in the best interests of the patient (which will invariably be the case, the intention) lies in negligence or nothing: Wilson v Pringle [1987] Q.B. 237.

APPRAISAL The law has to balance the interests of the patient with the interests of the doctor. The relationship is not inherently one of tension or conflict, but the possibility is always there. The patient is entitled to expect that the law will give him dignity, respect, independence, autonomy, self-determination, decision, infor­ mation. Everything said or done by the doctor must be in the best interests of the patient. Likewise the doctor is entitled to dignity, respect, autonomy, judgment. He has to ob­

39

serve demanding ethics and professional stand­ ards and heavy responsibilities and a high duty of care. Provided that he acted in good faith and in accordance with accepted contemporary professional practice he is entitled to be im­ mune from legal liability. The English courts, the judges in the House of Lords, have upheld the principle of freedom of clinical judgment. The doctor decides what shall and shall not be disclosed to the patient. He is not even required to discuss alternatives with the patient. The test is subjective, provided that it follows accepted professional practice, and is not way out on a limb. In policy terms, the medical profession are enabled to carry out their work with con­ fidence, free from legal action, free from the necessity of negative or defensive medicine.

CRITICISM The law is open to powerful criticism. The law is too deferential to doctors, too willing to accord them paternalistic authority, too willing to allow them to act without ac­ countability, to deny the patient the right to know. Traditional professional dominance is becoming unacceptable today. The ultimate decision, treatment or no treatment, treatment A or treatment B, should rest with the patient, and only the patient. It is his body. He should be entitled to be given all relevant information, all relevant information necessary to enable him to understand the is­ sues and to make his own decision, his own informed decision. Any information which would or could or might influence his decision ex hypothesi would be relevant. Is it something that a prudent hypothetical patient would want to know about? Is it something to which a patient would attach importance? The patient may make an unwise, irrational or silly decision. But that should be his right. The doctor is there to diagnose and inform and advise, not decide; to treat if asked. The patient may wish to take his decision on non-medical grounds, e.g., the impact upon his family or his business. The argument that disclosure may, in the opinion of the doctor, be harmful is unconvinc­ ing. The patient usually has a fair idea of what

40 Med. Sci. Law (1992) Vol. 32, No. 1

is wrong. Today he is usually better educated and better prepared and better equipped to face up to unpleasant realities and risks. Morally it is not right to conceal the real risk of death or disablement or other serious conse­ quence. Usually the patient asks anyway, and the law requires a full and truthful answer. The skilful doctor should know how to break un­ pleasant news: warn the patient in advance that unpleasant news may be coming; suggest disclosure through a spouse or relative; explain things in a professional, skilful and compas­ sionate manner, suited to the patient, so that the patient may get things into perspective. The doctor should not be able casually to get away with the bare minimum. Full, frank and candid disclosure should increase mutual con­ fidence and dialogue and enable both patient and doctor to play their part to the best ad­ vantage, to mutual advantage. Patient involvement can be meaningful and therapeutic. The patient can be greatly reas­ sured. The doctor would have to develop a much better understanding of the patient, much better communication and much better awareness of the psychology of the patient. The patient would be or become more mature, and be treated accordingly. The patient is not just a passive machine that needs mending; he is a living human being calling for information of physical, psychological and even moral mat­ ters. In imposing the duty of care, the law generally applies an objective test, not a subjec­ tive test. That is how standards, consistent and predictable standards, are set. It is not whether the defendant thought he was being careful; it is whether the judge says he was being careful. In judging a doctor regard should naturally be had to contemporary conventional wisdom and practice. Did this doctor in the event conform to the objective ordinary standard required of all doctors? Even in Sidaivay the judges recog­ nized that there may theoretically be extreme cases where as a matter of law the accepted practice would not suffice.

HALFWAY HOUSE There could be a sort of legal halfway house, as suggested by Lord Scarman in Sidaway, but

the halfway house is always logically unsatis­ fying, being a compromise. The law could say that the doctor must make disclosure unless he (the doctor) can prove a 'therapeutic privilege', a good reason for not disclosing, the judge to judge the issue on an objective basis. The doc­ tor would have to be altogether more aware o f the issue than the law now requires, because he could be called to account in respect of any non-disclosure. In the United States (though there are many jurisdictions) and in Canada the law appears to require disclosure (see Teff, 436-43).

PURPOSE FOR WHICH CONSENT SOUGHT The patient is asked if he will give blood, and he consents. He is told, or assured, that testing his blood is necessary for his treatment, as in­ deed it is. However, in addition the blood is tested for AIDS, perhaps because of suspicion in the case of this patient, perhaps as part of a preventive screening programme, perhaps as part of a research project. On discovering what has happened, the patient objects. Did he con­ sent? Was consent limited to the express or implied purpose, i.e., testing in his interests, or was it unrestricted? It is submitted that con­ sent must be limited to the extent of the information of the patient. Advice by Chief Medical Officer; AIDS and the Law, Diana Brahams (1987) 55 Medico-Legal Journal 192-3.

CLINICAL TRIAL Science and medicine must advance. There must be research. Clinical trials may be seen as desirable. But not in an unethical manner, and not so as to impose upon a patient or anybody else. There are two treatments, A and B, equally good in the opinion of the doctor. The doctor administers treatment A which he thinks is the best for the patient, or at any rate not inferior to treatment B. If the patient is put into a clinical trial, no legal duty to seek con­ sent simply because o f the doctor having chosen treatment A There are two treatments, A and B. B may be superior or inferior, it is unknown, or not clear. The doctor decides to administer treat­ ment B to the patient. If he believes that

Samuels: Informed Consent: The Law 41

treatment B is the better for the patient, no consent required. If he does not so believe, if he is interested to test treatment B, then full dis­ closure and fully understood consent is required. Indeed, the doctor should not even offer inferior treatment B to the patient. The doctor is supposed at all times to be acting in the best interests of the patient. The doctor cannot sacrifice or risk his patient, in the inter­ ests of knowledge for mankind, however beneficial the general good may be. There is the standard treatment, A. It has very limited efficiency. The patient will as­ suredly die within say six months. Treatment B is available, though the doctor has little faith in it and does not believe it to be better than treatment A However, in a near hopeless situa­ tion there may be something to be said for 'an outside chance'. Legally there probably is no requirement to seek or to obtain consent, if in clinical judgment it would not be in the inter­ ests to do so. The point is that in all these cases the doctor has to make a judgment, namely, what in my clinical judgment is the best treat­ ment for this patient in these circumstances. Anything that may detract from this overriding principle is untenable. Consent should always be obtained for any inferior treatment, and the validity of any consent to such inferior treat­ ment must be open to doubt. If the 'guinea pig" is not a patient but a volunteer, there must be full disclosure and consent. And the proposed treatment must not in any way be prospectively harmful to the guinea pig, so as to threaten life or general well-being. In law nobody can consent to the deliberate infliction of injury. See Randomised trials and informed consent, Diana Brahams (1989) 57 Medico-Legal Journal 46.

POLICY Ultimately the matter is one of policy. The pur­ pose of the law is to balance and reconcile competing interests in the public interest. Clinical freedom is a most important principle. The best interest of the patient is an even more important principle. BIBLIOGRAPHY Bennion F. Consent to surgery on mentally handi­ capped adult. (1989) Solicitors'J 133, 245

Brahams D. (1987) AIDS and the law. Med. teg. J 65, 192-3. Brahams D. Informed consent and randomised con­ trolled trials (1989) Law Soc. Gaz., 28 J u n e , 31. Brahams D. (1989) Randomised trials and informed consent. Med. Leg. J. 57, 46. Brahams D. (1989) Kidneys for sale. N.L.J. 139, 159. Brazier M. (1987) Medicine, Patients and the Law. Pelican. Chapters 4 and 18. Brazier M. (1987) Patient autonomy and consent to treatment: the role of the law? Legal Studies, 1G9. Farndale W. A. J. (1979) Law on Hospital Consent Forms, Ravenswood. Fortin J. (1988) Sterilisation, the mentally ill and consent to treatment, M.L.R. 5 1 , 634. Freeman M. (editor) (1988) Medicine, Ethics and the Law, Current Legal Problems. Stevens Hirsch S. R. (1988) Consent and the Incompetent Pa­ tient: ethics, law and medicine. Royal College of Psychiatrists. Jones M. (1986) Consent to medical treatment by minors. Professional Negligence, 2, 41. Kennedy I. (1988) Treat Me Right. O.U.P Kennedy I. (1984) M.L.R. 47, 454 (Sidmvay in Court of Appeal). Kennedy I. and Grubb A. (1990) Materkds in Medical Law, Butterworths. Knight B. (1987) Ij>gal Aspects of Medical Practice. Edition 4, Churchill Livingstone. Leigh-Taylor N. (1976) Doctors and the law. Gyez, chapter 10. Lewis C. (1985) Sterilisation and the surgeon's duty of disclosure. Professional Negligence, 2, 238. Lewis C. (1988) Medical Negligence, a Plaintiffs Guide. Frank Cass. Lockwood M. (ed.) (1985) Moral Dilemmas in Modern Medicine, O.U.P. McLean S. (1981) Legal Issues in Medicine, chapter 8, Gower. Mason J. and McCall-Smith R. (1987) Medico-Legal Encyclopedia. Butterworths. Mason J. (1987) Law and Medical Ethics. 2nd edition, Butterworths. Mason J. K. (1986) Consent to medical treatment. SCOLAG (J. Scottish Legal Action Group) 116, 73 and 77. Nicholson R. (1986) Medical Research with Children: ethics, law and practice, O.U.P. Ormrod R. (1989) Is consent really necessary? Med. Sci. Law, 29, 4. Pickup Z. (1988) Medical treatment of minors: whose consent? Practitioners Child Law Journal, 48. Poison C. J. (1985) The Essentials of Forensic. Me­ dicine. 4th edition, Pergamon, pp. 631-2, Robertson G. (1981) Informed consent to medical treatment. L.Q.R. 97, 102. Shaw J. (1987) Informed consent, a German lesson. l.C.L.q. 35, 864. Shaw J. Sterilisation of mentally handicapped people: judges rule OK? (1990) M.L.R. 53, 91 — commen-

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tary on F [1989] 2 W.L.R. 1025, H.L., with com­ parison with German law. Skegg P. D. G. (1973) Consent to medical procedures on minors. M.L.R. 36, 370. Skegg P. D. G. (1984) Law Ethics and Medicine. Clarendon, Oxford Part II — review article An­ drew Grubb (1987) 50 M.L.R. 241, esp. 249-55. Stone E. and Johnson H. (1987) Forensic Medicine. Waterlow. Symmons C. (1987) Problem of 'informed consent' in the wrongful birth cases. Prof. Negligence, 3, 56. Teff H. (1987) Law and ethics of medical experimen­ tation. Professional Negligence, 3, 182.

Teff H. (1985) Consent to medical procedures: pater­ nalism, self-determination, or therapeutic al­ liance? L.Q.R 101,432 Commentaries on Sidaway : I. Kennedy (1984) The patient on the Clapham omnibus, 44 M.L.R. 454, pre House of Lords. Andrew Grubb [1985] Cam­ bridge L.J. 199. Harvey Teff (1985) 101 L.Q.R. 432. Simon Lee (1985) 101 L.Q.R. 316. Journal of Medical Ethics — passim. Medicine, Science and the Law — passim. Medico-Legal Journal — passim. The Lancet — passim. Declaration of Helsinki 1964. (1988) Practitioner's Child Law Journal 48.

Informed consent: the law.

Samuels: Informed Consent: The Law 35 Informed Consent: the law A SAMUELS JP Barrister BA(Cantab) Formerly Member of the Council of the British Acade...
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