Consent Summary

Consent Fundamentals

  • Fundamental legal and ethical principle
  • Must be voluntary, informed, and from a person with capacity
  • Required for all examinations and treatments

Types of Consent

  • Explicit: Verbal or written agreement
  • Implied: Signalled by patient behavior
  • Not a one-off event - requires ongoing discussion

Decision Making Principles

  • All patients have right to be involved in decisions
  • Focus on meaningful dialogue and information exchange
  • Presumption that adult patients have capacity

Required Information

  • Diagnosis and prognosis
  • Treatment options including no action
  • Benefits, risks, and uncertainties
  • Nature of each option and likely outcomes

Emergency Treatment

  • Presume conscious patients have capacity
  • Provide immediately necessary treatment if lacks capacity
  • Treatment must be in patient's best interests

Decision Making And Consent

Medical guidelines for informed consent and patient decision making

Fundamentals of Consent

Consent is a fundamental legal and ethical principle. All patients have the right to be involved in decisions about their treatment and care and to make informed decisions if they can. The exchange of information between doctor and patient is essential to good decision making.

Valid Consent Requirements

For consent to be valid, it must be given voluntarily and freely, without pressure or undue influence, by an appropriately informed person who has the capacity to consent to the intervention in question.

Who Can Provide Consent

In adults, consent may only be provided by the patient, someone authorised under a Lasting Power of Attorney, or someone with court-appointed authority to make treatment decisions.

Ongoing Process

Consent is not a one-off event — ongoing discussion is needed as treatment evolves. Explicit or implied patient consent is needed for all examinations, treatments, or interventions.

Types of Consent

Clinical Note

Consent is required for all examinations, treatments, or interventions, with exceptions only for emergency treatment or when prescribed by law (e.g., compulsory treatment under mental health legislation).

Explicit Consent

When a person actively agrees verbally or in writing. Although a patient can give consent verbally, you should make sure this is recorded in their notes.

Implied Consent

Signalled by the behaviour of a person who is aware of and understands the proposed course of action. For quick, minimally invasive interventions, it may be reasonable to rely on non-verbal consent.

Principles of Decision Making and Consent

All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.
Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.
All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it.
Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives.
Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care.
The choice of treatment or care for patients who lack capacity must be of overall benefit to them, and decisions should be made in consultation with those close to them.
Patients whose right to consent is affected by law should be supported to be involved in the decision-making process.

Supporting Patients' Decision Making

The exchange of information between doctor and patient is central to good decision making. It's during this process that you can find out what's important to a patient, so you can identify the information they will need to make the decision.

Essential Information to Provide

Medical Context

  • Diagnosis and prognosis
  • Uncertainties about diagnosis or prognosis
  • Options for further investigation

Treatment Options

  • Options for treating or managing the condition
  • The option to take no action
  • Nature of each option and what would be involved

Risks and Benefits

  • Potential benefits of each option
  • Risks of harm and uncertainties
  • Likelihood of success for each option

Facilitating Understanding

Share information in a place and at a time when patients are most likely to understand and retain it.
Anticipate whether patients are likely to find any information distressing and be considerate when sharing it.
Accommodate a patient's wishes if they would like to record the discussion.
Accommodate a patient's wishes if they would like anyone else to be involved in discussions.
Use an interpreter or translation service if they have difficulty understanding English.
Share information in a format they prefer - written, audio, translated, pictures or other media.
Give them time and opportunity to consider information before and after making a decision.

When You Disagree with a Patient's Choice

Respecting Patient Autonomy

You must respect a competent patient's decision to refuse an investigation or treatment, even if you think their decision is wrong or irrational. You must not assume a patient lacks capacity simply because they make a decision that you consider unwise.

Respect Decisions - Respect a competent patient's decision even if you disagree. You may advise the patient of your clinical opinion, but you must not put pressure on them to accept your advice.
Check Understanding - If a choice seems out of character, check their understanding of the relevant information and their expectations about the likely outcome.
Offer Support - If it's not clear whether a patient understands the consequences of their decision, offer more support to help them understand the relevant information.
Explore Requests - If a patient asks for treatment you don't think would be clinically beneficial, explore their reasons, understanding, and expectations.
Explain Refusals - If after discussion you still consider that the treatment would not serve the patient's needs, explain your reasons and explore other options including their right to seek a second opinion.

Treatment in Emergencies

Emergency Considerations

In an emergency, decisions may have to be made quickly so there'll be less time to apply guidance in detail, but the fundamental principles remain the same.

Conscious Patients

You must presume a conscious patient has capacity to make decisions and seek consent before providing treatment or care, even in emergencies.

Unconscious Patients

If a patient lacks capacity and it's not possible to find out their wishes, you can provide treatment that is immediately necessary to save their life or prevent serious deterioration.

Treatment Choices

If there is more than one option, the treatment you provide should be the least restrictive of the patient's rights and freedoms, including their future choices.

Best Interests - Any treatment decision made in the absence of consent must be made in that person's best interests.
Ongoing Care - For as long as the patient lacks capacity, you should provide ongoing care.
Regaining Capacity - If the patient regains capacity while in your care, you must tell them what has been done and why, as soon as they are sufficiently recovered to understand.
Discuss Options - Discuss with them the options for any ongoing treatment once they have regained capacity.