Consent Flashcards
What are the 2 main types of consent?
Implicit: implied, e.g. rolling up sleeve for blood pressure reading.
Explicit: written or verbal consent e.g. surgery (written), blood sample (low risk procedure, verbal)
What is required for consent to be valid?
What is the main underlying ethical principle of consent?
- Competence and capacity
- Information (pt has been given all relevant and important info)
- Voluntariness (decision is free from coercion)
Autonomy is the main ethical principle underlying consent.
What does a a patient require to be deemed to have capacity?
When are they deemed to not have capacity?
Patient is deemed to have capacity if they have ALL of the following (1 or more lacking = lack of capacity):
- Ability to understand the information given to them relevant to the decision
- Ability to retain the relevant information long enough to make the decision
- Ability to use/weigh up information as part of the decision making process
- Ability to communicate decision (by any means)
Define coercion
What are the different types?
Explicit: a person is forced to make a decision (always invalid consent)
Implicit: a person is pressured to make a decision (e.g. financial pressure)
Power differentials in the patient/doctor relationship
Who should take consent?
Doctor performing procedure OR someone who is:
- Suitably trained or qualified AND
- Has sufficient knowledge of proposed intervention and risks AND
- Understands and agrees to comply with the GMC consent guidelines
What are the potential obstacles to informed consent?
How can these be overcome?
-
Poor information/time pressure during information provision
- Ensure adequate information provision
- Alternative sources of information (other members of healthcare team, leaflets)
-
Emergency situations
- Patients may be treated without consent in emergency situations provided treatment is required immediately to save life or prevent serious deterioration.
-
Langage barriers:
- NHS employed interpreter
-
Being rushed into a decision:
- Give patients time and space to consider options where possible.
-
Pressure/coercion by 3rd parties
- Speak to patient alone if possible
What is the purpose of informed consent?
To protect the rights and interests of indiviuals.
Treatment without consent = assault/battery
Define autonomy
Personal autonomy encompasses, at a minimum, self-rule that is free from both controlling interference by others and from certain limitations such as an inadequate understanding that prevents meaningful choice
For what is consent required in healthcare?
Treatment
Investigation
Examination
Disclosure of information
Research
Education
What information should be given to a patient in order for them to give informed consent?
Diagnosis and prognosis
Treatment options and their risks and benefits & alternative treatments (including the option not to treat)
What are the 3 forms of consent?
Give an example for each
-
Implied consent via compliance
- e.g. rolling up sleeve to have blood pressure taken.
-
Oral consent:
- e.g. when having blood taken
-
Written consent:
- For high risk/complex procedures such as surgery
- If there is potential for significant impact on person’s employment, social or personal life (e.g. HIV test)
- If treatment is part of a research study
- If clinical care is not the primary aim of the investigation/treatment
- Specific treatments such as fertility
For what is oral consent appropriate?
Low risk procedures (e.g. blood taking)
What is the significance of a written consent form?
A signed consent form is evidence (not proof) of valid consent. Consent is still invalid if:
- Patient lacked capacity
- Patient was coerced
- Patient was not provided with sufficient information
