Consent to External-Beam Radiotherapy

Canadian law, and the physician’s code of ethics, requires that informed consent be obtained before any medical act is performed. However, there are no rules about how consent is to be obtained and by whom, and how that consent is to be documented. In April 2008, we asked the heads of all Canadian radiation oncology departments to tell us whether their centre uses a written consent form for external-beam radiotherapy and, if it did, to send us a copy of the form or forms used. Responses were received from 29 of the 38 centres contacted (76%). In 12 centres, all of them in British Columbia or Quebec, no written consent is obtained. Of the 17 centres (59%) that do seek written consent, 9 use a generic hospital or cancer centre form. Only 5 use a form specific to radiotherapy that mentions multiple visits, photographs in the treatment position, use of tattoos, and so on, and only 2 use a form that is specific to the tumour type or site irradiated and that explains the risks associated with treatment. The final centre of the 17 did not provide a form for review. While current practice at the McGill University Health Centre is not out of line with that at other Canadian centres, the results of our survey suggest a need for dialogue on the subject of consent for external-beam radiotherapy.