Consent and medical treatment

Patients who have undergone surgery might recall signing a Consent Form prior to the procedure. In fact, ‘consent to treatment’ means a person must give permission before they receive any type of medical treatment, test, or examination. The information below outlines some of the issues that are central to the subject of 'consent'.

For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

Voluntary

The decision to proceed with treatment must be made voluntarily, free from any undue pressure, or coercion from healthcare providers, family, or other parties. A patient must be allowed the freedom to decide based on their own preferences, without fear of reprisal or guilt.

Informed

Informed consent in the context of medical treatment refers to the process by which a patient voluntarily agrees to undergo a medical procedure or treatment after being provided with all relevant information about the procedure's risks, benefits, alternatives, and potential outcomes. It ensures that patients have the autonomy to make an informed decision about their own healthcare, based on a clear understanding of what the treatment involves.

Capacity

The patient must be mentally capable of understanding the information provided. This includes being able to appreciate the nature of the condition, the proposed treatment, and its potential outcomes.

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected. This applies even if refusing treatment would result in death.

If a person does not have the capacity to make a decision about their treatment and they have not appointed a lasting power of attorney (LPA), the healthcare professionals treating them can go ahead and give treatment if they believe it's in the person's best interests but must take reasonable steps to discuss the situation with the person's friends or relatives before making these decisions.

If a patient has consented to treatment, they can change their mind at any point before the procedure.

Consent from children and young people

If they're able to, consent is usually given by patients themselves but someone with parental responsibility may need to give consent for a child up to the age of 16 to have treatment.

When consent is not needed

There are some circumstances in which consent might not be required before treatment – these include, but are not limited to situations where a person:

• needs emergency treatment to save their life, but they're incapacitated (for example, they're unconscious)
• immediately needs an additional emergency procedure during an operation - but there has to be a clear medical reason why it would be unsafe to wait to obtain consent
• with a severe mental health condition, lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act) - in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental health condition
• needs hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act) – this would require an application for the person to be forcibly kept in hospital, and an assessment by 2 doctors.

Consent and life support

A person may be being kept alive with supportive treatments, such as lung ventilation, without having made an advance decision, which outlines the care they'd refuse to receive.

In these cases, a decision about continuing or stopping treatment needs to be made based on what that person's best interests are believed to be. Healthcare professionals should discuss the issue with the relatives and friends of the person receiving the treatment in order to reach decisions about treatment. In some rare cases, where agreement isn’t reached, a case may be referred to the courts.

In our next article we will look in more details at issues affecting 'informed consent'.