Consent and medical treatment (2)

In our second blog article about consent we consider some of the information that patients should be provided with when they are considering options for medical treatment.

Nature of the Procedure:

The patient must be fully informed about what the medical procedure or treatment will entail. This includes details about the procedure itself, how it will be carried out, and what the expected outcomes are.

Risks and Benefits:

The healthcare provider must explain the potential risks (both common and uncommon) of the procedure or treatment, as well as the benefits. This allows the patient to weigh the pros and cons before deciding.

Alternatives:

The patient must be made aware of any alternative treatments or procedures that may be available, including the option of not having the treatment at all. This empowers the patient to make a decision that aligns with their values and preferences.

Possible Consequences of Refusal:

The patient should also be informed of the potential consequences of refusing the treatment or opting for an alternative treatment.

It's not enough for the healthcare provider to just give the information; the patient must demonstrate that they understand the information provided. This could involve a discussion with the patient, using simple language, and checking for understanding.

The Process of Obtaining Informed Consent

In an ideal scenario this would include the following steps:

Initial Discussion: A healthcare provider discusses the proposed treatment with the patient. This should include all the essential information about the procedure, including risks, benefits, and alternatives.

Clarification: The patient is encouraged to ask questions and express any concerns they may have about the treatment. The healthcare provider should be prepared to clarify any doubts.

Decision: After having had the chance to reflect on the information provided, the patient makes a decision about whether or not to proceed with the treatment.

Documentation: In most cases, informed consent is documented in writing, with both the patient and the healthcare provider signing a consent form. This form usually outlines the procedure, risks, benefits, and alternatives, but it is not just a formality. it should reflect the discussion that took place. In some circumstances, verbal consent may be appropriate (for instance, in emergency situations).

Of course, these steps can all take place at the same appointment, and in many cases patients are happy to agree to any treatment or investigations offered by a clinician, without any questions. However, any patient with queries or concerns should raise them at this stage, and ideally before signing a form. This will give clinicians an opportunity to explain or provide more information.

Why is informed consent important?

Patient Autonomy:

Informed consent is rooted in the principle of patient autonomy, which means that patients have the right to make decisions about their own bodies and medical care.

Ethical Obligation:

It is an ethical and legal obligation for healthcare providers to ensure that patients are properly informed. Failing to obtain proper informed consent can result in allegations of medical negligence, battery, or a violation of patient rights.

Trust in Healthcare:

Informed consent fosters trust between patients and healthcare providers. When patients feel that they are being fully informed and respected in their decisions, they are more likely to feel confident in their care.

Legal Implications of failing to obtain Informed Consent

In legal terms, informed consent may be a critical issue in medical negligence cases. If a patient suffers harm or injury as a result of a treatment they did not fully understand, or if they were not made aware of the risks involved, it may lead to a medical negligence claim.

Challenges facing patients and clinicians.

These include:

Medical complexity

Medical care involves complex and technical issues, and even relatively simple procedures can carry significant risks. It can be difficult for a clinician to simplify these matters in a discussion with a patient but also to ensure the patient has an adequate understanding of the issues.

Risk

A clinician suggesting a procedure may do so being aware that the treatment or investigation is the usual course of action for a patient’s symptoms or condition. The clinician will understand the risks of the procedure – those that are minor and common but also those that are serious but less common. Patients are not always in a good position to assess risk, or to understand the potential implications of those risks e.g a possible need for further surgery, longer term disability caused by nerve damage etc

Resolving the challenges

Clinicians have extensive training and specialist knowledge – but they also have strict legal and ethical obligations. Patients can help to ensure ensure that they are giving fully Informed Consent by:

• Asking questions … about alternative options, risks and benefits, and side-effects. But also about what will happen if they do not wish to proceed, and about the implications of the identified risks.
• Taking a written list of key questions to a consultation to ensure that everything is addressed before consent is given
• Asking a loved one to accompany them to an appointment so that they can provide support and ensure that the patient’s concerns have been addressed
• Reading leaflets about procedures (that are sometimes provided when a procedure is suggested as an option).