Information
Provision of information is key to obtaining valid consent. Unless patients have sufficient information, they are not in a position to decide what is best for them. In Good Medical Practice in Seeking Informed Consent to Treatment, the Medical Council has set out what patients ought to know before deciding whether to consent to treatment or an investigation (see Box 7, below).
Unless patients have sufficient information, they are not in a position to decide what is best for them
Discussion of all the issues surrounding a proposed investigation or treatment is an integral part of the patient’s clinical care. Discussions about the options available to the patient may take place over several consultations, all forming a part of the consent process. Clinical negligence claims alleging invalid consent rarely turn merely on the presence or absence of a consent form, but usually involve in-depth analysis of the information and advice provided to the patient and whether he/she was given all the information material to the decision.
When patients ask questions about proposed treatments and their available options, responses should be full and honest – thereis no place for omitting facts because the patient might be anxious or worry about the potential consequences. The only justification for withholding information from patients is where disclosure would be likely to cause serious harm to their mental or physical health. These circumstances are extremely rare.
If intervention is needed urgently, it may be impossible to provide all the information set out in Box 7; even so, the patient should be given a broad outline of what is being recommended and why, and if the patient asks questions, the doctor’s responsibility is to answer them.
Box 7: Information the patient should be given in the consent process
- Details of the diagnosis, and prognosis, and the likely prognosis if the condition is left untreated.
- Uncertainties about the diagnosis, including options for further investigation prior to treatment.
- Options for treatment or management of the condition, including the option not to treat.
- The purpose of a proposed investigation or treatment; details of the procedures or therapies involved, including subsidiary treatment such as methods of pain relief; preparation for the procedure; and what the patient might experience during or after the procedure, including common and serious side effects.
- For each option, explanations of the likely benefits and the probabilities of success; discussion of any serious or frequently occurring risks, and of any lifestyle changes which may be caused by, or necessitated by, the treatment.
- Advice about whether a proposed treatment is experimental.
- How and when the patient’s condition and any side effects will be monitored or reassessed.
- The name of the doctor who will have overall responsibility for the treatment and, where appropriate, names of the senior members of his or her team.
- Whether doctors in training will be involved, and the extent to which students may be involved in an investigation or treatment.
- A reminder that patients can change their minds about a decision at any time.
- A reminder that patients have a right to seek a second opinion.
- Where applicable, details of costs or charges that the patient may have to meet.
Medical Council, Good Medical Practice in Seeking Informed Consent to Treatment (2008), para 5.e having intercourse with or without treatment/contraception.