The issue of consent has a particular bearing on cardiac practice. Cardiac disease is common, has serious consequences, and frequently requires invasive investigations and treatments. In this issue there are several articles relating to the issue of consent. These range from the concise legal perspective1 to the actual data from studies assessing the patient's perspective.2-4 The issue of consent must be considered in the wider context.5 There is an ongoing social shift with a greater focus on the “individual” and away from the “community”. This has transformed many other spheres of society and is altering the doctor–patient relationship. Individuals wish to be more in control of their lives, or perhaps more importantly perceive to be in control of their lives, and that their individual needs are paramount. Although the individual's (or patient's) autonomy has long been recognised, in the past it has not been so strongly emphasised. This in part has been the result of the attitude of the medical professions, but cash constrained health care resources, with the implicit priority of achieving the greatest benefit for the greatest number of people with the least cost, has also played a pivotal role. Recently this change has occurred in accelerated phases after a number of high profile cases such as Bristol. Although at the time the reaction to these cases has not necessarily been considered, the reaction has strongly influenced the change process. There have been changes in interpretation of the law, which indirectly have had a bearing on how consent is obtained. A combination of “no win no fee” and Lord Woolf's reform of the …