What is consent?
Before a health professional – e.g.
doctor, nurse or therapist – examines or treats you, they need your
consent or permission.
You can give your permission in
different ways – by doing something to show you agree with
treatment, e.g. offering your arm for an injection; by verbally
agreeing to something; or by signing a form.
A written record of your decision (a signed form) is usually
needed if your treatment involves sedation, general anaesthesia or
surgery (where there is a fine balance between the benefits and
burdens or where there are likely to be serious consequences). If
you later change your mind, before the procedure, you are are
entitled to withdraw your consent - even after signing.
Can everyone give consent?
Some people, e.g. younger children or people who are mentally
incapacitated, cannot give consent because they do not fully
understand what they are agreeing to. Someone else will then have
to give consent on the patient’s behalf – e.g. parents, guardians,
welfare attorneys. Also, those with an interest in your welfare can
be involved in the decision regarding care.
Under the Mental Capacity Act 2005, if you are considering a
serious medical treatment and you cannot understand the care being
offered, so therefore cannot give your consent, (and there is no
one else with an interest in your welfare to give it for you), the
health professional will need to contact an Independent Mental
Capacity Act Advocate (IMCA).
The IMCA will then participate in the decision-making process to
support you. If the treatment is urgent or in response to an
emergency, the law says a doctor can treat you without referral to
an IMCA, if it will help you. You can find out more about consent
and IMCAs by visiting the Department of Health website
www.dh.gov.uk/consent%20 and
www.dh.gov.uk/MentalCapacityAct.
The Mental Capacity Act 2005 also allows you to award a Lasting
Power of Attorney (LPA) to someone else to make decisions about
your healthcare should you become incapacitated and unable to
consent to the care for yourself. This has to be awarded when you
are competent. Further information is available from the Office of
the Public Guardian www.publicguardian.gov.uk.. This
is different from a Power of Attorney / Eduring Power of Attorney,
which does not give the power to be involved in decisions about
your medical care.
What about emergency treatment?
In an emergency, you may not be able to agree to treatment. The
healthcare staff will still treat you without consent but they can
only do this if it will save your life or stop you suffering more
serious harm and there is no known LPA in place.
The rest of this information is about consenting for elective
(planned) procedures.
What should I know before giving my consent/permission?
Health professionals must ensure you have enough information
about your condition and treatment to enable you to decide which is
the best option for you. They will usually have given you a written
patient information leaflet at a previous appointment and before
they carry out any examination or treatment will also write
information on the consent form and offer you a copy to keep. In
your appointment they should also have discussed the various
treatment options available for your condition with you.
Although they may well recommend a particular option, you are
free to choose another if you feel that is right for you or you may
choose not to have any treatment at all – that is up to you.
People’s attitudes vary on things like the amount of pain they are
prepared to accept. That goes for the amount of information too. If
you would rather not know about certain aspects, discuss your
worries with whoever is treating you.
What sort of information do I need to decide?
In order to make a decision about accepting treatment options
you will need to know more about them – What will the treatment
involve? What are the benefits? What are the risks? What are the
alternatives? What will happen if I don’t have any treatment?
We will give you a list of suggested questions you may want to
ask your health professional later in this leaflet but please ask
anything you want. The person you ask should do his or her best to
answer, but if they don't know they should find someone else who is
able to discuss your concerns. It might be a good idea to bring a
friend or relative along with you to support you and prompt
questions, as there will be a lot to remember and you may feel very
anxious.
Who will treat me?
Amongst the health professionals treating you may be a 'doctor
in training' – medically qualified, but now doing more specialist
training. They range from recently qualified doctors to doctors
almost ready to be consultants. They will only carry out procedures
for which they have been appropriately trained. Someone senior will
supervise – either in person accompanying a less experienced doctor
in training, or available to advise someone more experienced.
What about anaesthesia?
If your treatment involves general or regional anaesthesia
(where more than a smalI part of your body is being anaesthetised),
you will be given general information about it in advance. You will
also have an opportunity to talk with the anaesthetist when he or
she assesses your general health shortly before treatment. Your
pre-operative assessment nurse will have already discussed the
likely anaesthesia options with you and will have asked you about
your current medications and allergies.
Will samples be taken during the procedure?
Some kinds of operation involve removing a part of the body
(such as a gall bladder or a tooth). You would always be told about
this in advance. Other operations may mean taking samples as part
of your care. These sampIes may be blood or smalI sections of
tissue, for example of an unexplained lump. Such sampIes may be
further checked by other health professionals to ensure the best
possible standards. Again, you should be told in advance if sampIes
are likely to be taken. Sometimes, sampIes taken during operations
may also be used for teaching, research or public health monitoring
in the future interests of all NHS patients. The NHS Trust treating
you will have a local system for checking whether you are willing
for this to happen.
Photographs and videos
As part of your treatment ,some kind of photographic record may
be made – for example, X-rays, clinical photographs or sometimes a
video. You will always be told if this is going to happen. The
photograph or recording will be kept with your notes and will be
held in confidence as part of your medical record. This means that
it will normally be seen only by those involved in providing your
care or those who need to check the quality of care you have
received.
The use of photographs and recordings is also extremely
important for other NHS work, such as teaching or medical research.
However, we will not use yours in a way that might allow you to be
identified or recognised, without your express permission.
Giving your consent – a summary
It is your decision! It is up to you to choose whether or not to
consent to the treatment that is being proposed. Ask as many
questions as you like, and remember to tell the team about anything
that concerns you or about any medication, allergies or past
history, which might affect your generał health.
Some suggested questions to ask
- What are the main treatment options?
- What are the benefits of each of the options?
- What are the risks, if any, of each option?
- What are the success rates for different options – nationally,
for this unit, or for you personally (the surgeon)?
- Why do you think an operation (if suggested) is necessary?
- What are the risks if I decide to do nothing?
- How can I expect to feel after the procedure?
- When am I likely to be able to get back to work?
Questions may also be about how the treatment might affect your
future state of health or style of life, e.g.:
- Will I need long-term care?
- Will my mobility be affected?
- Will I still be able to drive?
- Will it affect the kind of work I do?
- Will it affect my personal/sexual relationships?
- Will I be able to take part in my favourite
sport/exercises?
- Will I be able to follow my usual diet?
Healthcare professionals should welcome your views and discuss
any issues so they can work in partnership with you for the best
outcome.