What is consent?
- CONSENT IS THE PERMISSION TO DO SOMETHING
- ‘patient’s voluntary agreement to treatment,
examination or other aspects of health care’. - Consent is the ethical cornerstone of all medical
interventions
What does a doctor-patient relationship contain?
- Respect of patient autonomy
- Primacy of consent
The main ideas of WMA DECLARATION ON THE RIGHTS OF THE PATIENTS
Right to self-determination
Consent and patient rights
What is informed consent?
- the term ‘consent’ implies waiving our rights and permitting
others to do things that they would otherwise not be
allowed to do - The concept of informed consent in medicine applies
equally to - acceptance of treatment,
- choice among possible treatments
- refusal of treatment
What is informed/ valid consent?
For consent to be valid it should be
* Given by a patient who has capacity to make decisions about his
or her care
* Voluntary, that is free from pressure, coercion or persuasion
* Sufficiently informed
*Additional component: For consent to be valid it should also be
Continuous
1) the patient should be informed that they can change their
mind at any time
2) should be repeatedly gained in the course of the
consultation in relation to specific procedures, i.e. physical
examination or blood examinations
What are the three requirements for informed/ valid consent?
- Competence
- Voluntariness
- Information
What is the information the patient needs before making a decision?
- Procedure (what it is for, what it entails, what it will feel like,
nature and purpose) - Alternatives (including nothing)
- Risks (of the procedure/treatment, including risks of doing
nothing) and Benefits - Questions (including checking patient’s understanding)
What does professional guidance include?
- Clear, accurate information about the RISKS
- presented in a way patients can understand.
- identify the adverse outcomes
- potential outcome of taking no action.
- Risks can take a number of forms, but usually:
- a side effects
- b complications
- c failure of an intervention to
achieve the desired aim
What is the information needed by the patient according to GMC Guidance?
a) the diagnosis and prognosis
b) any uncertainties about the diagnosis or prognosis, including
options for further investigations
c) options for treating or managing the condition, including the
option not to treat
d) the purpose of any proposed investigation or treatment and
what it will involve
e) the potential benefits, risks and burdens, and the likelihood of
success, for each option; this should include information, if
available, about whether the benefits or risks are affected by
which organisation or doctor is chosen to provide care
f) whether a proposed investigation or treatment is part of a
research programme or is an innovative treatment designed
specifically for their benefitg) the people who will be mainly responsible for and
involved in their care, what their roles are, and to what
extent students may be involved
h) their right to refuse to take part in teaching or research
i) their right to seek a second opinion
j) any bills they will have to pay
k) any conflicts of interest that you, or your organisation,
may have
l) any treatments that you believe have greater potential
benefit for the patient than those you or your organisation
can offer
What are the types of consent?
- Consent may be explicit or implied.
- Explicit (also known as express) consent is given when a patient
actively agrees to the use or disclosure of information - Expressed verbal consent
- Written consent
- Implied consent refers to circumstances in which it would be
reasonable to infer that the patient agrees to the use of the
information, even though this has not been directly expressed.
➢Consent need not be written but documentation may provide
evidence of the consent process
What legal frameworks of human rights should be considered?
- UN Declaration of Human Rights
- National Legislation
- UK - The Human Rights Act 1998
Including the rights to - life
- be free from inhuman or degrading treatment
- (respect for) privacy and family life
- freedom of expression
- be free from discriminatory practice
What is neglecting to take consent?
- breach of rights,
- Disrespect of Autonomy
- Non treating patient with Dignity
- Anti-professional behavior; Not following legal and
professional guidance
How can you respect patient’s autonomy?
- PRECONDITIONS
* Competence/ability to understand and decide
* Voluntariness in deciding - INFORMATION
* Disclosure of information
* Recommendation of a plan
* Understanding of information and plan - CONSENT
* Decision (in favor of a plan)
* Authorization (of the chosen plan)
What are the benefits of consent?
- Consent has therapeutic power and critical impact on care
- manifestation of ethical care in which people are recognised as
individuals with own priorities, anxieties, perspectives - more control over their care
- more realistic expectations
- more cooperative
- establish a relationship of trust
- respect and recognition of the value of the human person, etc
- Consent and the ways in which people approach it may vary
- the constant remains the commitment on the part of
professional and patient
Exceptions to the requirement for informed consent?
- Situations where patients voluntarily give over their
decision-making authority to the physician or to a third
party.
This may be because of
* the complexity of the matter
* or because the patient has complete confidence in
the physician’s judgement
* or on the basis of cultural ideologies. - Instances where the disclosure of information would cause
harm to the patient
What is therapeutic privilege?
- Allows physicians to withhold medical information if disclosure
would be likely to result in serious physical, psychological or
emotional harm to the patient, - for example, if the patient would be likely to commit suicide if the
diagnosis indicates a terminal illness. - physicians should make use this privilege only in extreme
circumstances.
Why would you withhold information?
- You should not withhold information necessary for making
decisions for any other reason, including when a relative,
partner, friend or carer asks you to, unless you believe that
giving it would cause the patient serious harm. - If you withhold information from the patient you must record
your reason for doing so in the patient’s medical records, and
you must be prepared to explain and justify your decision.
When is consent not necessary?
- in a medical emergency
- ‘Doctrine of necessity’ used
What is capacity?
- Capacity is a legal concept not a medical concept
- THE ABILITY TO GIVE PERMISSION TO HAVE TREATMENT
- OR TO WITHHOLD PERMISSION AND REFUSE TREATMENT
- All choices and decision-making in a clinical context flow from
assessment of capacity - Forms part of consent (competence)
What does the WMA Declaration of Patient Rights say about consent?
- If the patient is unconscious or otherwise unable to express his/her will,
informed consent must be obtained, whenever possible, from a legally
entitled representative. - If a legally entitled representative is not available, but a medical
intervention is urgently needed, consent of the patient may be presumed - unless patient’s previous firm expression or conviction that he/she would
refuse consent
What are the principles of the UK Law regarding capacity?
❑Every adult has the right to make his/her own decisions and to
be assumed to have capacity unless proven otherwise
❑ Everyone should be encouraged and enabled to make decisions
or participate in decision-making
❑ This includes people’s right to make apparently eccentric or
unwise decisions
❑ Proxy decisions should be made in the patient’s best interests
❑ Proxy decisions should be “the least restrictive of basic rights
and freedoms”
What does the Mental Capacity Act say the patient withy capacity should be able to do?
- Understand (the information relevant to the decision)
- Retain (the information)
- Use or weigh (the information as part of decision-making process)
- Communicate (his/her devision whether orally, in written, using sign language or other form)
Why is capacity a dynamic concept?
➢An individual’s capacity to make particular decisions may be
temporarily affected by factors such as pain, fear, confusion or
the effects of medication.
➢Assessment of capacity must be time and decision-specific.
What should a patient with capacity be able to do?
❑ understand in simple language what the medical treatment is, its
nature and purpose and why it is being proposed;
❑ understand its principal, benefits, risks and alternatives;
❑ understand in broad terms the consequences of not receiving the
proposed treatment;
❑ retain the information for long enough to make an effective
decision;
❑ make a free choice
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Week 141
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Week 244
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Week 336
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Week 428
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Week 516
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Week 7 - Ethics & Professionalism (flipped classroom)7
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Week 7 - Doctors & Patients11
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Week 8 - End of Life Ethics19
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Week 9 - Abortion21
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Week 10 - Organ Donation & Transplantation ethics17
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Week 11- Research Ethics17
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Week 11 - Public Health Ethics (FLIPPED CLASSROOM)12
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Week 12 - Human Rights9
