I would say that pretty well universally in medical education there are units or modules that are a mandatory part of training on informed consent. That training covers the ethical, legal and clinical dimensions of the issue of informed and valid consent.
Beyond what happens in formal medical education settings, there are organizations like the Canadian Medical Protective Association, which obviously is the liability insurer, if you like, for the medical profession in Canada. It has a very strong interest in making sure that providers fully understand their responsibilities around informed consent legally, ethically and clinically as well. They have a lot of resources available.
In hospitals and other institutions, beyond the realm of formal undergraduate or graduate training, issues of consent are very complicated. It is the case that within hospitals on any given day hundreds of informed consent situations are encountered in the interactions between providers and patients. So in hospitals there are people whose responsibility it is to engage with providers who are in the course of making decisions informing patients about treatment options and wanting to be assured that they in fact have secured appropriate consent from patients.
I'm just recounting this, not that I'm an expert on the legal aspects of informed consent. I'm not and I don't purport to be or wish to be interpreted as such. I just want to make the point that there is both the formal training that medical students receive and also an ongoing dialogue about consent issues throughout a practitioner's career.
With respect to a particular discipline—and again I want to underscore that I'm not an expert on this—inasmuch as certain specialists are permitted to do some procedures, or to propose those procedures and to implement them in their areas of specialization, there is some consideration of how consent would apply to those particular procedures. In the obstetrics and gynecological world, because of the kinds of procedures those individual specialists are permitted to pursue, they would need to consider how they would discuss treatment or interventions and what would constitute appropriate advice and, therefore, an appropriate determination of whether or not a patient has actually given consent relative to the procedures they are authorized to pursue.
There is a specialist-specific dimension to the issue of informed consent. This all assumes that the process is working well. It assumes that due consideration is given to the circumstances of the individual patient who is discussing a treatment procedure with the provider. This is where issues around cultural safety and sensitivity and awareness of cultural difference and the circumstances of patients come into play. What may be a completely appropriate conversation with one patient may not be taken appropriately into account in the circumstances of another patient. While it may look like informed consent had been achieved, it may not have been, given the circumstances of an individual patient.