‘More than a signature’: Navigating the ethics of consent in hospitals

Obtaining consent from patients is not simply about avoiding lawsuits or following policy, according to Dr Sunder Mehran Khan and Dr Afshan Afshan

It was 8:15am on a busy surgical ward. Dr Ahmed, already running behind on his pre-theatre round, stopped by Mrs K’s bed. She was scheduled for a laparoscopic cholecystectomy. Mrs K, a recent immigrant with limited English, smiled politely as Dr Ahmed quickly outlined the procedure and handed her the consent form. The ward was noisy, the clock was ticking, and the interpreter booked for her had been delayed. After a few nods, she signed.

Hours later, as she was wheeled into recovery, Mrs K appeared distressed. Through her daughter, she explained she hadn’t realised there was a risk of conversion to open surgery — the very reason she was now in more pain than she had expected.

This scenario, though fictional, mirrors a common ethical dilemma in hospitals: When time, language, and systemic pressures collide, is the consent process truly informed? Consent is one of the most important safeguards of patient autonomy, requiring that the individual understands the nature, benefits, risks, and alternatives of a proposed intervention. But in the fast-moving hospital environment, obtaining consent can become compressed into a hurried transaction, especially before routine or low-risk procedures. The danger is that it becomes a tick-box exercise rather than a meaningful conversation.

Language barriers remain a key challenge. Without timely access to trained interpreters, vital nuances about risks or alternatives may be missed. In such cases, the ethical question arises: Can we honestly say a patient has made an informed choice when their comprehension is incomplete?

Cultural expectations add further complexity. Some patients expect — or prefer — family-led decision-making, while hospital policies are often designed for individual consent. Balancing respect for cultural norms with the legal requirement to obtain consent from the patient themselves demands skill and sensitivity.

Time pressure is perhaps the most universal factor. Overbooked theatres, staff shortages, and heavy patient loads can unintentionally erode the quality of consent discussions. Clinicians often find themselves torn between the urgency of clinical workflow and the ethical imperative to provide adequate time for patient understanding. While technology — such as video explanations or simplified consent forms — can help, it cannot replace the human dialogue that builds trust and addresses patient concerns in real time.

History

To appreciate the gravity of this issue, it is worth recalling why informed consent exists at all. Historically, medicine was more paternalistic: Doctors made decisions on behalf of patients with little explanation. Scandals such as the Tuskegee syphilis study in the United States, and similar ethical failures worldwide, underscored the dangers of excluding patients from decisions about their own bodies. Out of these lessons emerged the modern principle of autonomy: The right of individuals to make choices about their medical care, provided those choices are based on adequate understanding. Informed consent is therefore not a formality. It is a cornerstone of medical ethics, rooted in respect for the patient as a person rather than a passive recipient of treatment.

Yet, as Mrs K’s story illustrates, the gap between principle and practice remains significant. When a patient signs a form without grasping its content, the legal box may be ticked, but ethically the process is incomplete. The consequences extend beyond confusion or regret. Inadequate consent can damage trust in healthcare, fuel litigation, and perpetuate health inequalities. Vulnerable groups — including those with language barriers, limited literacy, or cultural differences — are disproportionately affected.

Resources

What, then, can be done? One approach is structural: Ensuring interpreter services are not seen as optional extras, but as essential resources. Hospitals must invest in timely, reliable access to professional interpreters rather than relying on family members, whose presence may compromise accuracy or confidentiality. Training clinicians in cultural competence is equally vital. Understanding that some communities prefer collective decision-making does not mean abandoning individual consent, but it does mean adapting communication styles to respect both legal standards and cultural realities.

Another solution lies in rethinking time. Consent cannot be meaningful if it is rushed moments before surgery. Ideally, discussions should begin well before the day of the procedure, allowing patients time to reflect, consult loved ones, and ask questions. This requires systemic change: Realistic scheduling that acknowledges communication takes time, and that informed patients ultimately improve outcomes by reducing misunderstandings and disputes.

Technology offers both promise and pitfalls. Digital platforms with translated videos, interactive consent forms, or patient portals can supplement conversations, particularly when staff are stretched thin. However, they must be carefully implemented. A video cannot replace the reassurance of a clinician addressing a patient’s unique fears, nor can an online form pick up on hesitation in a patient’s voice. Technology should enhance, not replace, human interaction.

Respect

Ultimately, the consent process is as much about empathy as it is about information. Patients do not merely need facts; they need to feel heard, respected, and supported. When a clinician pauses to ensure understanding — by asking a patient to repeat key points in their own words, for example — they signal that the patient’s voice matters. This human touch transforms consent from a bureaucratic hurdle into a partnership.

Ultimately, the consent process is as much about empathy as it is about information

The lesson from cases like Mrs K’s is clear. A signature on paper is not the end of consent; it is the outcome of an informed, empathetic exchange. Hospitals must ensure systems and cultures support this — through interpreter availability, training in cultural competence, realistic scheduling, and thoughtful use of technology.

Because when a patient says ‘yes’, it should mean they know exactly what they are agreeing to — and that their decision is respected as much as the procedure itself.

Consent, then, is not simply about avoiding lawsuits or following policy. It is about honouring the dignity of patients at moments of profound vulnerability. In a healthcare system under pressure, it may be tempting to cut corners. But true consent demands we resist that temptation, recognising that every patient deserves not just treatment, but the respect of being a partner in their own care.

Dr Sunder Mehran Khan is a Basic Specialist Trainee (General Internal Medicine) at University Hospital Limerick. Dr Afshan Afshan is a GP