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Are patients in acute myocardial infarction sufficiently competent to understand what they are being told?
The study by Ågård and colleagues,1 published in a previous issue of Heart, raises the question of whether or not patients with acute myocardial infarction (AMI) can give informed consent to their treatment. At its most simple, “Consent is a state of mind: a decision by a patient”.2 In practice consent is valid if: (1) the patient is competent; (2) the patient is informed; and (3) consent is freely given. It has been defined as: “an autonomous authorisation by individuals of a medical intervention or of involvement in research… a person must do more than express agreement or comply with a proposal.”3
Ågård and colleagues1 reported on a survey of Swedish cardiologists and their perception of the informed consent process in interventional trials in AMI.1 The vast majority (86%) felt that patients were unable to understand all the information given to them, and so, by definition, were unable to give fully informed consent. A quarter of those who responded to the questionnaire went further. They believed that patients in AMI could never have enough understanding to give fully informed consent.
UNDERSTANDING THE ISSUES SURROUNDING CONSENT
What evidence is there that patients themselves fail to understand all the issues in the consent process, when acutely ill? Yuval and colleagues4 found that only 31% of 129 patients, who took part in the ISIS-4 trial, perceived that they had full comprehension of the trial, while 19% felt that they had no understanding of the trial.4 Poor understanding of research protocols was also reported in patients with unstable angina and non-Q wave AMI. …