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Informed consent

Duties of a doctor (GMC)

  • Make the care of your patient your first concern
  • Treat every patient politely and considerately
  • Respect patients' dignity and privacy
  • Listen to patients and respect their views
  • Give patients information in a way that they can understand
  • Respect the rights of patients to be fully involved in decisions about their care
  • Keep your professional knowledge and skills up to date
  • Recognise the limits of your own professional confidence
  • Be honest and trustworthy
  • Respect and protect confidential information
  • Make sure that your personal beliefs do not prejudice your patients care
  • Act quickly to protect patients from risk if you have good concerns to believe that you or a colleague may not be fit to practice
  • Avoid abusing your position as a doctor
  • Work with colleagues in the ways that best serve patients interests

Informed consent

  • Patients autonomy must be respected at all times
  • Patients can determine what treatment that they are or are not willing to receive
  • They have the right to decide not to undergo a treatment
  • This could adversely affect outcome or result in their death
  • Patients must be given sufficient information to make these decisions
  • Obtaining informed consent is not an isolated event
  • It involves a continuing dialogue between doctor and patient

Types of consent

  • Express consent - oral or written
    • Needed for most investigations or treatments with risks attached
    • e.g. consent for operation
  • Implied consent
    • Non-written consent when patient co-operates with a particular action
    • e.g. physical examination

Information required for valid consent

  • When obtaining consent patients should be informed of:
    • Details of diagnosis and prognosis with and without treatment
    • Uncertainties about the diagnosis
    • Options available for treatment
    • The purpose of a proposed investigation or treatment
    • The likely benefits and probability of success
    • Any possible side effects
    • A reminder that the patient can change his or her mind at any stage
    • A reminder that the patient has the right to a second opinion
  • All questions should be answered honestly
  • Information should not be withheld that might influence the decision making process
  • Patients should not be coerced
  • The person who obtains consent must be:
    • Suitably trained and qualified
    • Have sufficient knowledge of the proposed treatment and its risks

Specific problems

  • No-one else can make a decision on behalf of a competent adult
  • No-one can give or withhold consent on behalf of a mentally incapacitated patient
  • Court approval should be obtained for controversial treatments not directed at a metal disorder
  • In an emergency a life-saving procedure can be performed without consent
  • All actions must, however, be justifiable to ones peers

Children

  • At age of 16 years a child can be presumed to have the capacity to decide on treatment
  • Below the age of 16 years the child may have the capacity to decide depending on their ability to understand what the treatment involves
  • If a competent child refuses treatment a person with parental responsibility may authorise treatment which is in the child's best interests

Bibliography

Ashford R U,  Scollay J,  Harrington P.  Obtaining informed consent.  Hosp Med 2002;  62:  374.

Crowe S.  Obtaining consent in the elderly patient.  Hosp Med 2002;  63:  61.

Furness P M.  Obtaining and using human tissues for research:  ethical and practical dilemmas.  Hosp Med 2003;  64:  198-199

Sedgwick E.  Patients' right to refuse treatment.  Hosp Med 2001;  63:  196-197.

 

 
 

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