We at the Canadian Medical Protective Association (CMPA) read with interest the CMAJ article, “Informed consent for clinical treatment.”1 We were disappointed that this article was authored exclusively by American physicians and relied almost entirely on American case law and literature and, as such, did not address some of the important legal principles of informed consent that are unique to Canada.
The CMPA is a leader in Canada in the area of medicolegal risk management and has extensive experience with topics such as informed consent. The CMPA would have welcomed the opportunity to submit an article to CMAJ on this important medicolegal concept. Indeed, the CMPA has published numerous articles on the subject of informed consent, including a comprehensive booklet for its members entitled, Consent: A Guide for Canadian Physicians.2
The CMPA appreciates that the authors of this article acknowledge that “it is important for clinicians to determine the precise standard used in their jurisdiction and to adapt their practice accordingly. The Canadian Medical Protective Association provides detailed information on Canadian standards (www.cmpa-acpm.ca).”1 However, the article should have more clearly emphasized at the outset that the information is based on American legal principles and does not specifically address well-established Canadian legal principles, most notably “material risk.”
Given the significance of this Canadian legal concept, CMAJ may wish to consider clarifying that Canadian physicians should discuss “material risks” when obtaining informed consent from their patients. The determination of what constitutes a “material risk” requires consideration of what a reasonable person in the circumstances of the particular patient would want to know.