Informed consent enjoys an unassailable position in both clinical and research situations as a safeguard of patients’ rights. Keeping the patient involved in the decision making process is easier when there is direct communication with the individual. The Pakistani milieu offers challenges to this process because crucial decision making is often done by family members or is left entirely up to the attending physician. There seems to be a general acceptance of this shifting of focus from the individual to other (...) players. This also raises certain ethical dilemmas for physicians who may feel uncomfortable with communication which excludes the patient or in accepting a paternalistic primary decision making role. The objective of this informal qualitative study was to ascertain physicians’ perceptions regarding the process of information delivery to the patient in the Pakistani context and the various influences acting upon it. (shrink)