Consent is the permission that you must gain from a patient before you conduct any medical procedure. All patients have the right to be involved in their medical care and make informed decisions about it.

Consent

The GMC provides guidance on decision making and consent which is consistent with the law in all 4 countries in the UK. This guidance provides a framework for doctors to base their decisions on to ensure that they are practising medicine both ethically and legally.

In order to be legally valid, consent must be:

 Voluntary: the decision made must be the patient’s own, not influenced by friends, relatives, or medical professionals ✅

 Informed: before seeking consent, you must provide the patient with all necessary information about the procedure (this includes things like potential side effects, benefits, risks, alternatives etc.) 📃

 Given by an adult who does not lack the capacity to make decisions regarding their own health

How consent can be given:

 Verbally: e.g. “Yes” ✅

 Non-verbally (assumed): e.g. patient pulls their sleeve up to receive an injection ✅

 Written: e.g. patient signs consent forms ✍

 Consent can be withdrawn by the patient at any point if they change their mind ❌

Exceptions to the requirement for consent:

 Emergency, life-saving treatment of an unconscious patient 🚑

 Severe mental health conditions which impair the patient’s ability to make an informed decision (e.g. dementia/ bipolar etc.) 🧠

 Emergency requirement for additional procedures to be performed during surgery

 Patients who pose a risk to society/public health (e.g. communicable diseases)

Capacity

 Capacity is the ability to comprehend information and utilise it to make a decision 🧠

 Capacity (competency) should be assessed when consent is required, as it can change over time ⌛

 Capacity can be impacted by:

1. Dementia
2. Mental health conditions e.g. bipolar, schizophrenia etc.
3. Brain damage e.g. stroke, injury etc. 🧠
4. Learning disabilities
5. Intoxication e.g. drugs and alcohol 🍻
6. Temporary factors e.g. fatigue, shock, medications or panic

 In order to be considered competent, the answer to the following questions must be yes:

1. Does the patient understand the information provided?
2. Can the patient remember the information being provided to them?
3. Can the patient assess the benefits and risk to come to a decision
4. Can the patient communicate their decision to you?

 Capacity becomes complicated when you factor in personal beliefs such as religious beliefs (e.g. not to accept blood transfusions) which you must respect

Lack of capacity:

 If a patient is considered to lack the capacity to make their own decisions, a ‘best interest’ decision should be made on their behalf (you must act in their best interests) 🧠

 If no one can make a decision on their behalf, an Independent Mental Capacity Advocate should be consulted, or in some situations, court rulings may be required

 If it is predicted that a patient will lose their capacity in the future, they can make ‘advanced decisions’ whilst they maintain the capacity to understand the information e.g. dementia patients ⌛

DNAR forms:

 DNAR = Do Not Attempt Resuscitation  ✍

 A signed DNAR form informs health-care professionals that the patient does not want to be resuscitated in the case of cardiac arrest 📃

Young adults and children:

 Unlike adults, children in the UK are presumed to lack the competency to make decisions regarding their own medical care unless they can prove otherwise 👧

 The legal rights for children to give consent varies by age:

1. 18 and over: legally considered competent to consent to, or refuse treatment, unless they lack capacity
2. 16 & 17: legally considered competent to consent to or refuse treatment unless they lack capacity, however, their decisions can be overruled by parents/the law
3. Under 16: can consent to treatment if deemed competent, however, they cannot refuse treatment and their consent can be overruled by parents (disagreement between parents will be decided in court)

 Like with adults, in emergency scenarios in which waiting for parental consent could put the child at risk, a doctor can proceed with life saving treatment without consent 🚑

Gillick and Fraser guidelines:

 These guidelines provide criteria which medical practitioners must apply when offering contraception to people under the age of 16, without parental consent 👱:

1. The patient must understand the advice the professional gives them
2. The patient cannot, under any circumstances, be persuaded to inform their parents
3. They are likely to start or continue having sexual intercourse regardless of whether you offer them contraception
4. Their physical or mental health, or both, is likely to suffer if they do not receive contraception
5. It is in their best interests to receive contraception, with or without parental consent

Mental Health Act:

 The Mental Health Act (2005) provides the legal framework for making decisions on behalf of patients who lack mental capacity to make their own 🧠

 It applies to people over 16 years of age 👱

 Key principles:

1. You must assume someone has capacity unless it is established otherwise
2. You should not treat someone as being unable to make a decision unless every step has been taken to help them do so
3. You must not treat someone as unable to make a decision just because you regard their decision as unwise
4. Any decision made on behalf of someone under this act, must be made in their best interests
5. Before a decision is made and the act is done, you must ensure the desired outcome cannot be achieved in another manner, which is less restrictive to their rights/freedom

Summary

1. Consent must be gained before any medical procedure is carried out, including everything from a discussion to surgery
2. Consent must be voluntary, informed and given by a competent individual
3. Consent can be given verbally, non-verbally, or written and can be withdrawn at any point
4. In some emergency situations or where a patient lacks competency, consent is not required
5. A patient must have capacity to give consent (this is the ability to understand information provided and make a decision based on it)
6. Capacity depends on the individuals mental health and age