Informed or Assumed? Ethical Gaps in Surgical Consent Practices in Low-Resource Settings: A Narrative Review

Saeid Amini Rarani

doi:10.26550/2209-1092.1404

Authors

Saeid Amini Rarani Isfahan university medical sciences https://orcid.org/0000-0003-4700-0211

DOI:

https://doi.org/10.26550/2209-1092.1404

Keywords:

informed consent, surgical ethics, low-resource settings, patient autonomy, cultural considerations

Abstract

Background: The aim of this study is to examine the ethical gaps in surgical consent practices in low- and middle-income countries (LMICs) and identify the challenges in implementing informed consent principles in these settings. The article seeks to propose strategies for improving surgical consent processes specifically in LMICs.

Methods: This study follows a narrative literature review approach, synthesizing existing research on informed consent practices in LMICs. A comprehensive search was conducted across databases such as PubMed, Scopus and Web of Science for relevant articles. Inclusion criteria involved qualitative and quantitative studies addressing ethical considerations and systemic and cultural barriers in the surgical consent process. Data were analysed using the four principles of biomedical ethics: autonomy, beneficence, non-maleficence and justice.

Findings: The review identifies six key ethical concerns: superficial consent processes, compromised patient understanding, structural and systemic barriers, cultural influences on patient autonomy, consent obtained under emotional duress and institutional culture that perpetuates ethical erosion.

Conclusion: In many LMIC settings, the surgical consent process has become more of a procedural task than a meaningful ethical practice. To address this, a shift toward process-based approaches, investment in ethical communication training, localization of consent materials, cultural sensitivity without compromising ethics and strong institutional leadership is essential.

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