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Paul Banaszkiewicz Paul Banaszkiewicz Section Editor
Lorgan Lorcan McGonagle Segment Author

Section editor: Paul Banaszkiewicz

Segment author: Lorcan McGonagle

Document history: 1/8/2019

  • Valid consent must be confirmed before starting treatment, physical investigation or providing personal care.
  • For consent to be valid, it must be given voluntarily by an appropriately informed person who has the capacity to consent to the intervention in question (this will be the patient or someone with parental responsibility for a patient under the age of 18 years, someone authorised to do so under a Lasting Power of Attorney or someone who has the authority to make treatment decisions as a court-appointed deputy). Acquiescence when the person does not know what the intervention entails is not “consent.”
  • A person lacks capacity if:
  1. They have an impairment or disturbance (for example a disability, condition or trauma or the effect of drugs or alcohol) that affects the way their mind or brain works.
  2. That impairment or disturbance means that they are unable to make a specific decision at the time it needs to be made.1
  • A person is unable to make a decision if they cannot do one or more of the following things:
  1. Understand the information given to them that is relevant to the decision
  2. Retain that information long enough to be able to make the decision
  3. Use or weigh up the information
  4. Communicate their decision
  • People may have capacity to consent to some interventions but not to others, or may have capacity at some times but not others.
  • Some people may wish to know very little about the treatment that is being proposed. If information is offered and declined, it is good practice to record this fact in the notes. However, it is possible that individuals’ wishes may change over time, and it is important to provide opportunities for them to express this.
  • GMC and BMA guidance encourages doctors to explain to patients the importance of knowing the options open to them while respecting a person’s wish not to know, and states that basic information should always be provided about what the treatment aims to achieve and what it will involve.
  • During an operation it may become evident that the person could benefit from an additional procedure that was not within the scope of the original consent. If it would be unreasonable to delay the procedure until the person regains consciousness (for example because there is a threat to the person’s life) it may be justified to perform the procedure on the grounds that it is in the person’s best interests. However, the procedure should not be performed merely because it is convenient. For example, a hysterectomy should never be performed during an operation without explicit consent, unless it is necessary to do so to save life.
  • The task of seeking consent may be delegated to another person, as long as they are suitably trained and qualified.
  • No one is able to give consent to the examination or treatment of an adult who lacks the capacity to give consent for themself, unless they have been authorised to do so under a Lasting Power of Attorney or they have the authority to make treatment decisions as a court-appointed deputy.
  • People aged 16 or 17 years are presumed to be capable of consenting to their own medical treatment, and any ancillary procedures involved in that treatment, such as an anaesthetic. As for adults, consent will be valid only if it is given voluntarily by an appropriately informed young person capable of consenting to the particular intervention. However, unlike adults, the refusal of a competent person aged 16–17 years may in certain circumstances be overridden by either a person with parental responsibility or a court.
  • Gillick competence: children (under 16 years) who have sufficient understanding and intelligence to enable them to understand fully what is involved in a proposed intervention will also have the capacity to consent to that intervention.43
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