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. |