The report recommends that: Patients must be given such information as enables them to participate in their care'. It suggests processes for improving the conveyance of information such as ensuring that information is evidence based, and that importantlyinformation should be tailored to the needs ,circumstances
and wishes of the individual'. Such an approach if it becomes current in medical
practice will surely represent a critical shift to a prudent patient' test. It is also reflected in recent GMC guidanceSeeking Patient Consent: the ethical con-
siderations' ,GMC London ,1999.
The courts ,as indicated above ,appear to be increasingly prepared to scrutinise
the standard of disclosure profferred by health care professionals. It may also be
the case that in the future should information be withheld from patients ,claims
will be brought under the Human Rights Act 1998. The trend is towards disclosure
and this should be welcomed as part of the nurse's partnership in clinical practice
with her patient. Co-operation rather than conflict will surely facilitate better
patient care.
The questioning patient
The nurse may give the patient some explanation of the procedures and potential
risks of their treatment but the patient may later approach the nurse and ask for
further information. How should the nurse respond? In the House of Lords in
Sidawaysome of the members of the court indicated that there might be an
obligation to provide a full reply if questions are asked. Lord Bridge said that:
`when questioned specifically by a patient of apparently sound mind about the
risks involved in a particular procedure proposed ,the doctor's duty must ,in my
opinion be to answer both truthfully and as fully as the questioner requires.' [62]But these statements were obiter and not binding. Subsequently inBlythv.
Bloomsbury AHA,?1987) ,Lord Justice Kerr said that there was no obligation to
disclose all information when a question was asked; it was sufficient if the infor-
mation given was that which would be given by a responsible body of medical
practitioners ± theBolamtest. He stressed that the response of health care
professionals to the patient's questions should depend on factors such as the
circumstances ,the nature of the information ,its reliability and relevance and the
condition of the patient. That case was however decided in 1987 and needs now
surely to be placed in its historical context: recent judicial statements indicate a
move towards willingness to recognise an obligation to answer questions ?e.g.
Pearcev.United Bristol Healthcare NHS Trust?1999)). The DoH have suggested
that:
`If information is offered and declined ,it is good practice to record this fact in
the notes. However it is possible that patients' wishes may change over time and
it is important to provide opportunities for them to express this.' [63]The recommendation of Professor Ian Kennedy in the Bristol Infirmary Inquiry
Final Report ,emphasising that patients should be given the opportunity to ask
questions and to seek clarification and more information ,should be noted in this
context. Following the Bristol Inquiry Report the Department of Health have issued
Consent and the Capable Adult Patient 115