Ian Paterson denied his patients autonomy. Unfortunately, so do many NHS doctors

Almost every single doctor in the NHS believes they are supporting their patients to make sound, autonomous decisions about their health. Unfortunately, most of them are getting it wrong, writes Alexis Paton

‘Monster’ surgeon Ian Paterson was jailed for 15 years in 2017, a sentence that was subsequently increased to 20 years (PA)

In the wake of the report on rogue breast surgeon Ian Paterson, questions are being raised about what patient consent and autonomy really mean. That the struck-off surgeon managed to operate on so many women without them properly consenting has brought to light how important information and understanding are to patient autonomy. Paterson may have “informed” his patients about what he wanted them to know, but in omitting and lying about important aspects of their diagnosis and care, the consent he obtained was far from the gold standard of “informed consent” required by the NHS and the law.

After all, patient consent is much more than a signature on a page – it is the immutable line that medical professionals cannot cross. A patient’s right to make decisions about their own healthcare, their autonomy, is considered almost absolute. Consent is enshrined in law and medical ethics, not just in Britain but across the globe. That patients have a properly informed understanding of the decisions they are making is part of this right. In the UK, to overturn a patient’s decision on their care requires drastic action. They must be incapable of understanding the decisions they have to make. They are deemed incompetent, sectioned for their own wellbeing, or taken to court so that others can gain decision-making powers over their healthcare.

Almost every single doctor in the NHS believes they are supporting their patients to make sound, autonomous decisions about their health. Respect for this autonomy is part of good clinical practice. Unfortunately most of them are getting it wrong, and they don’t even know it.

Over a decade of research from the social sciences has continued to highlight how patient autonomy and informed consent are rhetorically revered, but that in reality, patients report a lack of support when making decisions. Patients often feel confused, unheard, rushed, misunderstood, and unable to challenge their doctor when making a decision. The recommendation of the Paterson report for “a short period introduced into the process of patients giving consent for surgical procedures, to allow them time to reflect on their diagnosis and treatment options” shows just how much further medicine has to go in facilitating patient autonomy.

Giving patients time to understand the information given to them, so they can make the right decisions, is a fundamental part of person-centred care. Person-centred care, and its sister concept, shared decision-making between patient and doctor, are core values of the NHS. That the Right Rev Graham James should recommend this time is unsurprising to the academic world.

Shared decision-making means being given the space to identify concerns. To voice and discuss issues, allowing patients to make decisions with the doctor that may ultimately be other than those recommended by the doctor. It is a complex relationship that needs space and time to work effectively, and space and time are in short supply in the NHS right now. Properly supporting patients to make autonomous decisions about their healthcare is a critical part of ethical medical practice, but this seems a tall order when the most a patient gets with their doctor is somewhere between seven and ten minutes. It is no wonder that medicine continues to get it wrong when it comes to supporting patient autonomy. There simply isn’t time to do so.

There are many lessons to be learnt from what Paterson did. However, amidst fixing the individual and systemic failings that allowed Paterson to operate unchecked, one of the larger lessons is surely this: that the healthcare sector still has a lot of work to do to ensure patient consent is more than a tick in a box. To truly give patients autonomy, we must safeguard the space and time for them to make some of the most difficult, life-changing and irreversible decisions they will ever face.

Dr Alexis Paton is a lecturer in social science applied to health at the University of Leicester, chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, and a trustee of the Institute of Medical Ethics. She writes in a personal capacity