Informed consent
Cosmetic Surgery - Plastic Surgery - Aesthetic Medicine - Reconstructive Surgery
Article 36 (Article R.4127-36 of the French Public Health Code)
The consent of the person to be examined or treated must be sought
in all cases. When the patient, who is able to express his/her will,
refuses investigations or treatment, the doctor must respect this
refusal after having informed the patient of its consequences. If the
patient is unable to express his/her wishes, the physician cannot treat
him/her unless his/her relatives have been warned and informed, except
in an emergency or where relatives cannot be contacted. . The
physician's obligations towards the patient when the latter is a minor
or a protected adult are set out in Article 42.
Any decision taken by a patient for surgery must be the subject of an
informed consent, which is to say that the surgeon should not omit or
conceal anything from his patient. The Act of March 4, 2002 states in
this regard "no medical procedure or treatment can be performed without
the informed consent of the person and that consent can be withdrawn
at any time.”
This law is a fundamental step in regulating the practice of plastic
surgery in the health system by strengthening the obligations of
practitioners and regulating aesthetic surgery clinics. For the
purposes of informed consent, advertising is prohibited, and an
estimate, as well as the most complete information possible on the
surgical procedure(s) to be performed, is required.
In the particular field of plastic, reconstructive and aesthetic
surgery, the dialogue between the surgeon qualified in aesthetic
surgery and his patient is fundamental to trying to identify the
genuine will of the patient, his/her deep desire to match the image of
his/her body with what he/she feels deep down. . Caution is always
advised before any transformative surgery. Informed consent is essential
in the patient's decision making process.
Key questions to ask include: Does the deformity exist? Does the
deformity affect patient's psychology or not? Is there a safe and
effective surgical method for correcting this deformity? After
correcting this deformity, will the patient experience a psychological
benefit? The purpose of all these questions is to give the patient full
information so that he/she can think about the strategy, risks and
outcomes that are proposed and then take the decision to undergo the
surgery or refuse it freely. The patient has the right to accept or
reject what the doctor is offering and not have it imposed on him/her.
This patient's freedom is a fundamental ethical requirement, a
corollary of the duty to provide information contained in the preceding
article. Providing a patient's information is indeed a prerequisite
for his consent, a consequence of what he/she draws from this
information (art 35.). Like all surgical procedures, aesthetic surgery
entails, risks and the law requires the practitioner to inform the
patient of all of them. There are therapeutic risks, anaesthetic risks,
the risk of bleeding, infection risks, risk of scarring and risks
associated with different implants and specific to each of them.
There are also risks related to the result, with the possibility that
the patient is disappointed by that result (unsightly, too visible, not
natural, etc.) The origin of a bad result is, in most cases, an
incorrect diagnosis, a strategic mistake, or a combination of both.
The final risk that exists in relation to any surgical intervention is
directly related to patient's motivation and personality. This risk
exists in the case where the dialogue between surgeon and patient
showed an initial demand which differs from the search for harmony or
the repair of a visible defect causing suffering. This may be the case
where the demand comes from an adolescent whose personality is not
fully developed, or where parents take children to a consultation even
though they do not want anything done. . There are also other cases,
however, where the patient may consider he will achieve a change of
life by the mere intervention of aesthetic surgery.
Informed consent allows the patient to understand, after receiving
information from his doctor which is clear, understandable and
appropriate to his capabilities, the nature of the actions and
prescriptions proposed, their benefits for his health and the adverse
consequences of refusal. The doctor helps him to think about things,
gives him the explanations he requires, can correct errors in
understanding and remind him of information he does not remember
properly. . Informed consent is not an end in itself but the mark of a
good relationship with the patient. The surgeon, through consultation
and informed consent, will guide the patient in his/her willingness or
otherwise to go ahead with surgery.