The major challenges militating against the proper practice of informed consent identified in our desk top review are related to cultural issues of the people. Many patients continue to value strongly their kinship ties with the past and believe in the traditional methods of healing sickness. The patients must be given some information about what the doctor proposes to do. The underlying spirit of informed consent is new in PNG, and it strives against the traditional attitudes of doctors that they know it best for the patients and the strong culture in customs and patients' misconceptions that affect their perceptions in making important health care decisions. Majority of the patients have some notion of informed consent, however not many people understand what it is. They still hang onto their traditional customs, beliefs and opinions that affect their health care decisions; they often look to their village elders, family and parents for advice in times of sickness or death in the family but where the law implies consent it is not often obtained. Summarization of current laws, reports of legal cases, and personal experiences were examined. Special requirements must be prescribed when patients are subjected to medical treatment. Documentation of a well-defined process, not only on paper, may not only protect the medical doctor from exposure to liability but increases the patient's autonomy in decisions concerning health and encourages compliance with treatment; and advances the interests of both patient and doctor. Lack of informed consent can reinforce a claim of medical malpractice, and could well undermine relevant health care policy to protect patient autonomy.

This work is based on an on-going research on medical informed consent in Papua New Guinea (PNG) with 19 doctors from hospitals, health care centers and private medical establishments in the National Capital District and Central Province who voluntarily participated in the study. The authors conducted an examination of doctors' understanding of informed consent for medical procedures through a qualitative interview study and we describe our findings. We saw a need to involved patients in decision-making about their care, ethical imperative and concerns about litigation and their complaints highlighted the issue of informed consent. In order for the patients to make an informed decision about medical procedure, the doctors involved in the proposed treatment should conduct the informed consent discussion. The discussion should include the treatment, the risks and benefits of treatment, and alternative therapies with associated risks and benefits. We studied doctors' perspectives of gaining informed consent for routine medical procedures. We used qualitative study methods using structured interviews selected by purposive sampling. The data collected were entered into a data base and were analyzed thematically. The discussion is based on review of legal decisions, commentaries and our personal experience in studying medical malpractice cases. We have utilized case reports and several informative writings that have appeared in the world literature, as well as selections from vast amounts of material available in USA, UK, Australia, India and PNG. The current informed consent processes do not appear to be ideal for many doctors in PNG. In particular, there are inhibiting factors that affect patients from making medical informed decisions, doctors find time not enough to run discussions on informed consent, Department of Health does not have a standard informed consent form, patients complain about no consent form, and they have not signed consent forms. These are but some issues that affect patients when trying to make informed decisions. We say that informed consent process flows from the relationship between doctor and patient, however when this does not occur, serious legal and ethical consequences may result. This report is not intended to be specific advice on any private legal matter.

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During a semi-structured interview we ask the participants several questions based on the perceived role of the interviewee within the informed consent process. We asked questions pertaining to how informed consent unravels itself across barriers. Few question topics included how the issue of socio-economic, geography and custom of the people are addressed, and how the medical professionals deal with different groups of people and how the interviewees understood informed consent. Interviews for each group were asked with different sets of questions and were open enough to allow for probing questions in order to gain additional information when the opportunity presented itself. The data were analyzed using interpretative approaches and the various themes and concepts from each question and response qualitatively counted and uncovered patterns in the various group perspectives. We examined the participants' perspectives and opinions using a visual table for comparing themes and concepts, and we presented the interviewees' views.

This study explores how doctors and patients in Papua New Guinea (PNG) perceive informed consent in medical settings. Doctors and patients from National Capital District and Central Province who responded to the survey were the participants of the study. Researchers asked the participants to fill out questionnaires regarding their knowledge about informed consent for each group, namely, the doctors and participants. From those who responded, six randomly selected participants were chosen to join the focus group discussion which aimed to get experiences from the doctors and patients regarding medical procedures. Results show that both doctors and patients lack knowledge of the legalities of informed consent. Based on the experiences of doctors, they do not use consent forms when seeking permission from patients. Patients, on the other hand, do not see consent forms as important and only served as a formality. Customs, culture surrounding PNG were found to have an impact on how patients perceived informed consent.