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Stephen Wear, Washington DC, Georgetown University Press, 1998, 200 pages, £15.75.
The appearance of a second edition of Stephen Wear's 1993 book is a well-deserved compliment to the first edition. Those who were convinced by the operational model of informed consent presented in the first edition will be pleased to learn that the new edition does not include any substantial changes. As the author himself indicates in the preface the basic argument is the same as are the main conclusions.
For the benefit of those who are not familiar with the first edition (reviewed in these pages in April 1995), the author's main aim is to offer a realistic model of informed consent which would be of real value to practising clinicians. “Mention informed consent to a clinician and my experiences is that you are more likely to get a groan, as well as talk about the `myth of informed consent'. Seldom will one encounter a clinician who sees informed consent as simply a useful tool for medical management”(page 2).
Wear's model consists of three stages. During the first two the physician provides information to the patient, whereas during the third, and interactive, stage the patient should be pressed, if necessary, to provide some feedback, so that the doctor can see whether the patient has sufficiently understood what is at stake and is thus able to reach a better informed decision. This is particularly important when crucial, value-charged issues are involved.
The second edition contains a short new section called The clinician's discretion (located near the end of the book), where the author compares his model of informed consent with the “transparency” model of Howard Brody. It is the third, interactive stage in his model that he sees as the major difference from Brody's. The second edition also attempts to remove any confusion or lack of clarity in the text to which critics have drawn the author's attention. It is to be hoped that the practitioners for whom the book is intended as a useful “tool” will find its second edition to be a “perfected tool” which will contribute to the silencing of the groaners about informed consent.