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Consenting a patient for a procedure

Explaining the procedure

  • Explain what it is
  • Reason for it
  • Explain procedure details (before, during, after)
  • Risks and benefits 
  • Alternatives

Three things required for consent to be valid

  1. Consent must be informed
  2. Consent must be voluntary
  3. Patient must have capacity

Consent test

In order to provide valid consent, the patient must do all four of the following:

4 rules for consent testing

  • Understand = Understand information relevant to the decision (e.g. consequences, risks, benefits, alternatives)
  • Retain = Retain the information (for long enough to make a decision)
  • Weigh up = Weigh up and use the information to make a decision (pros and cons)
  • Communicate

Other points

  • A signed consent form is best practice but not a legal requirement
  • The person consenting must have a full understanding of the procedure, risks, benefits and alternatives
  • The ultimate responsibility for ensuring the patient is consented properly lies with the doctor undertaking the procedure (although they do not have to do this personally)
  • You must disclose ‘all risks that are material to the patient’

Consent rules for children

Children 16-18 years old

  • Children 16-18 years old are presumed to have capacity and generally treated like adults with regard to consent. However, unlike adults, treatment refusal can be overridden in some circumstances (by person with parental responsibility or court).

Gillick competence for children under 16 years old

  • Children under 16 years old can consent to medical treatment (but not necessarily refuse treatment) ‘if they have sufficient maturity and judgement to enable them to fully understand what is proposed’ – i.e. they are ‘Gillick competent’

IF THEY ARE COMPETENT: child can consent to treatment on their own (parents cannot override) 

IF THE ARE NOT COMPETENT: parent is responsible for consent (unless it’s an emergency and they cannot be contacted)

IF A COMPETENT CHILD REFUSES TREATMENT IN THEIR BEST INTERESTS: settled by the court (emergency court decision can be obtained)

IF A CLINICIAN DISAGREES WITH A PARENT: settled by the court (emergency court decision can be obtained)

Fraser guidelines for prescription of contraceptives 

  • A doctor can prescribe contraception to children under 16 years old if:
    • The child understands the advice
    • They cannot be persuaded to tell their parents
    • They are likely to continue having sex without the contraception
    • The child’s physical/mental health may suffer without the contraception
    • The child’s best interests are that they should receive it                  

NB: bear in mind the age of the partner and risk of sexual abuse.

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