BMJ Case Reports Requires a Signed Consent Form Without Exception

BMJ applies the ICMJE principle through its own machinery, and the machinery is where the work is.

The form is BMJ’s. “We will need the patient to sign our consent form, which requires the patient to have read the article.” A consent form from your hospital, however carefully drafted, does not substitute, because it will not have been signed against this article.

Signatures are wet. “Please note we do not accept forms that are electronically signed.” This surprises people more than anything else on the page, and it has a practical consequence: a patient consenting remotely has to print, sign and return a physical document.

BMJ Case Reports has no exception. The general BMJ policy allows some latitude where material is genuinely anonymous; the page states that this does not apply for BMJ Case Reports, which requires a signed patient consent form without exception. The submission guidance repeats it: “For all submissions authors are required to provide a signed BMJ patient consent form.”

Deceased patients, in BMJ Case Reports. “A document must be submitted confirming that exhaustive attempts have been made to contact the family”, and BMJ asks authors to seek permission from the next of kin as a matter of courtesy and medical ethics.

Minors. “If the patient is under the age of 18, we require parents or guardians to provide consent on behalf of the minor.”

Images. Images may be used without consent only where they are anonymised by the removal of any identifying marks. BMJ “accepts medical photographs cropped to preserve a patient’s dignity and privacy” — cropping, not barring.

Requiring the patient to have read the article is the substantive part, and everything else is enforcement of it. A signature on a form that describes publication in the abstract tells you nothing about whether this patient would consent to this text.

The wet-signature rule looks like bureaucracy and is really about provenance. BMJ has to be able to show, if challenged, that a particular person signed a particular document. In a world of paper-mill submissions and fabricated cases, a form that cannot be forged in a browser is worth the inconvenience.

And the no-exception rule for Case Reports reflects what that journal is: almost every article in it is about one identifiable person, so an exception process would become the normal route.

BMJ also reserves the right to refuse to publish any manuscript that does not comply, which makes this the rare policy with its consequence stated on the same page.

How it differs by journal. BMJ applies the policy publisher-wide, but singles out BMJ Case Reports for the stricter, no-exception rule. For the other BMJ titles, genuinely anonymous material — images with every identifying mark removed — can be used without consent.

Compared with other publishers. The wet-signature requirement is unusual, and a form prepared for another journal will not be accepted. If you are considering BMJ Case Reports among several targets, take BMJ’s form at the outset: it will satisfy a journal with a looser requirement, and the reverse is not true.