Consent

Introduction
Consent is permission granted by a person allowing you to subject them to something;
anything from physical examination to surgical procedures.
Performing an act on a competent adult without their consent constitutes a criminal offence.

Capacity
The patient must be able to understand what a procedure involves, the possible consequences
of a decision or of failure to make a decision. All adults are assumed to have capacity unless
demonstrated otherwise.

Assessing capacity
The patient must be able to:
 Understand the information including any consequences.
 Retain the information.
 Weigh the information as part of decision making.
 Communicate their decision.
A patient lacking capacity
Your reasons for believing a patient lacks capacity to make a certain decision should be
clearly documented.
A patient may become temporarily incapacitated by, for example, acute confusion. Treatment
may only be carried out in these circumstances if it cannot reasonably be delayed until
incapacity is resolved. If this is the case, treatment must be decided according to the best
interests of the patient.
Voluntary consent
Consent is only valid if given voluntarily, without pressure from relatives, friends, or medical
professionals.
Information
Patients must be provided with sufficient information to enable them to make an informed
decision. Information must include:
 What the procedure entails and the rationale for doing it.
 Any alternatives available.
 Significant risks. This includes any ‘significant risk which would affect the judgement
of a reasonable patient’, not just those risks deemed significant by a responsible body
of medical opinion (the Bolam test). Failure to disclose such risks may render you
guilty of negligence.
 Additional procedures that may be necessary under the same anesthetic should be
discussed during initial consent.
  If patients refuse information about a procedure, this should be clearly documented,
and the patient provided with the opportunity to discuss later.
Consent forms
 Written consent is evidence that consent has been sought but does not confirm its
validity.
 If consent is not voluntary, information is lacking, or the patient lacks capacity, then
consent is not valid regardless of the presence of a consent form.
 Certain procedures require written consent.
 Consent that is oral or non-verbal may also be valid.
Who should seek consent?
Ideally, the professional providing the treatment or investigation in question, though
this is not always possible.
The professional seeking consent should at least have sufficient knowledge to
understand and explain the procedure, its indication, and any risks involved.
If you are asked to seek consent for a procedure but lack this knowledge, it is your
responsibility to seek advice from colleagues; failure to do so may result in invalid
consent.
Refusal to consent
 If an adult with capacity refuses to give consent for a procedure, this must be
respected (except in specific circumstances), even if refusal will lead to death of the
patient or their unborn child.
 In these circumstances, rigorous examination of a patient’s competence is necessary.
 The same is true if a patient withdraws consent at any time, if they still have capacity.
Advanced refusal
• Advance refusal is valid if made at a time when a patient is competent and appropriately
informed.
• Applicable when patient lacks capacity.
• Failure to respect the refusal may result in legal action.
• If doubt exists as to validity, the courts must be consulted.
Adults lacking capacity
o May be temporary, permanent, or fluctuating.
o No-one may give consent on behalf of an incompetent adult, unless a valid Lasting
Power of Attorney exists.
o Patients must be treated in their best interests (not just medical interests) taking into
account psychological, religious/spiritual, and financial well-being.
o Those close to the patient should be involved unless the patient has previously made
clear that they should not be; independent patient advocacy services exist for
consultation when the patient does not have anyone close.
o Where there is doubt as to best interests or capacity, the High Court may give a ruling.
Lasting powers of attorney (Mental Capacity Act 2005)
A document created by someone (the ‘donor’) to confer authority to give consent for
investigation or treatment (as well as other issues) to a named individual(s) (‘donees’).
Must be registered.
Only valid when the patient lacks capacity.
Must specifically authorize the donee to make decisions regarding welfare or medical
treatment.
Unless specifically stated, do not extend to decisions about life-sustaining treatment.
Patients under 18 years of age 16–17 years
If competent, may consent to or refuse an intervention.
If incompetent, an individual with parental responsibility may provide consent.