Consent is taken when two or more persons agree the same thing in the same sense.

While repeating this statement which came up in the session, UNAIDS Ethics Advisor Maria raised a basic question that how can informed consent equalise things which are fundamentally unequal.

Anand Grover from Lawyers Collective replied that the need to disclose information arises only between unequal partners, and therefore the need to have informed consent remains as vital as before. Because there is inequality, informed consent becomes an obligation, he said.

Focussing on the biggest dilemma in this issue of ethics, and attempting to universalise the ethical guidelines, Maria said that irrespective of whatever principles on ethics we set, at the end of the day the ethical practices that get framed and are eventually followed, are formed by a function of factors like socio-economic, legal or political context, which too vary from region to region.

A delegate from Zimbabwe said that informed consent is used more often to protect doctors in medico-legal cases than to inform the patients of the treatment and management they are consenting to undergo, or to protect the patients´ right to know.

Another delegate from South Africa said that she could not understand the informed consent offered to her at the hospital, despite her proficiency in English and educational background. She stressed the need to have informed consent in local languages and an easy to understand manner.

Anand Grover said that in the UK, doctors have a right to treat and manage patients, which is in stark contrast to the US, where patients’ rights take a front seat. Canada offers a balance of doctors’ and patients’ rights.

But in India, many times informed consent and law overlap. For instance on the issue of confidentiality, doctors are supposed to protect the confidentiality in the public interest, and not in the private interest, but when protecting confidentiality poses a risk to public interest, then they have to change their stand, he said.

Anand said that adult patients with a sound mind have an absolute right to chose whether to consent to medical treatment, even if their choice is “irrational.”

Many of the delegates attending this session felt that there should have been more debate on this issue. This session on issue of ethics left many unanswered dilemmas, as per the post-session informal interview with the delegates.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team