Consent

Question 1

What are the 2 main types of consent?

Answer 1

Implicit: implied, e.g. rolling up sleeve for blood pressure reading.

Explicit: written or verbal consent e.g. surgery (written), blood sample (low risk procedure, verbal)

Question 2

What is required for consent to be valid?

What is the main underlying ethical principle of consent?

Answer 2

• Competence and capacity
• Information (pt has been given all relevant and important info)
• Voluntariness (decision is free from coercion)

Autonomy is the main ethical principle underlying consent.

Question 3

What does a a patient require to be deemed to have capacity?

When are they deemed to not have capacity?

Answer 3

Patient is deemed to have capacity if they have ALL of the following (1 or more lacking = lack of capacity):

• Ability to understand the information given to them relevant to the decision
• Ability to retain the relevant information long enough to make the decision
• Ability to use/weigh up information as part of the decision making process
• Ability to communicate decision (by any means)

Question 4

Define coercion

What are the different types?

Answer 4

Explicit: a person is forced to make a decision (always invalid consent)

Implicit: a person is pressured to make a decision (e.g. financial pressure)

Power differentials in the patient/doctor relationship

Question 5

Who should take consent?

Answer 5

Doctor performing procedure OR someone who is:

• Suitably trained or qualified AND
• Has sufficient knowledge of proposed intervention and risks AND
• Understands and agrees to comply with the GMC consent guidelines

Question 6

What are the potential obstacles to informed consent?

How can these be overcome?

Answer 6

• Poor information/time pressure during information provision
  
  • Ensure adequate information provision
  • Alternative sources of information (other members of healthcare team, leaflets)
• Emergency situations
  
  • Patients may be treated without consent in emergency situations provided treatment is required immediately to save life or prevent serious deterioration.
• Langage barriers:
  
  • NHS employed interpreter
• Being rushed into a decision:
  
  • ​Give patients time and space to consider options where possible.
• Pressure/coercion by 3rd parties
  
  • ​Speak to patient alone if possible

Question 7

What is the purpose of informed consent?

Answer 7

To protect the rights and interests of indiviuals.

Treatment without consent = assault/battery

Question 8

Define autonomy

Answer 8

Personal autonomy encompasses, at a minimum, self-rule that is free from both controlling interference by others and from certain limitations such as an inadequate understanding that prevents meaningful choice

Question 9

For what is consent required in healthcare?

Answer 9

Treatment

Investigation

Examination

Disclosure of information

Research

Education

Question 10

What information should be given to a patient in order for them to give informed consent?

Answer 10

Diagnosis and prognosis

Treatment options and their risks and benefits & alternative treatments (including the option not to treat)

Question 11

What are the 3 forms of consent?

Give an example for each

Answer 11

• Implied consent via compliance
  
  • ​e.g. rolling up sleeve to have blood pressure taken.
• Oral consent:
  
  • e.g. when having blood taken
• Written consent:
  
  • For high risk/complex procedures such as surgery
  • If there is potential for significant impact on person’s employment, social or personal life (e.g. HIV test)
  • If treatment is part of a research study
  • If clinical care is not the primary aim of the investigation/treatment
  • Specific treatments such as fertility

Question 12

For what is oral consent appropriate?

Answer 12

Low risk procedures (e.g. blood taking)

Question 13

What is the significance of a written consent form?

Answer 13

A signed consent form is evidence (not proof) of valid consent. Consent is still invalid if:

• Patient lacked capacity
• Patient was coerced
• Patient was not provided with sufficient information