CONSENT WITH CAPACITY

• Giving and obtaining consent is usually a process
• start as soon as a patient is offered a procedure, so that s/he has time to assimilate the information
• provide literature / leaflets where possible
• if the situation changes, revisit

• Doctor in charge of patient’s care/surgeon capable of performing the procedure should be the person gaining consent from the patient

• Use a standard Trust consent form

• By name
• By date of birth
• By hospital number and/or NHS number

• If patient is not offered enough information to make a decision in a form s/he can understand, consent will not be valid and may be challenged
• If patient does not speak English, do not proceed further until an approved interpreter is available
• do not use a family member/friend to interpret
• document interpreter’s identity on consent form/in medical records
• consent form must be signed by patient, doctor and interpreter (unless interpretation via telephone)
• Allow patient to make a balanced decision about proposed procedure/treatment by giving sufficient information about material risks
• purpose, benefits and material risks, alternatives
• present information in an open and unbiased way
• document in notes what leaflet provided
• Ensure patient understands explanation
• After full discussion of procedure or operation with patient, allow him/her to read the consent form and leaflets provided

Key Information

• Diagnosis and prognosis
• uncertainties about the diagnosis or prognosis, including options for further investigation
• Options for treating or managing the condition, including the option to take no action
• the nature of each option, what would be involved, and the desired outcome
• the potential benefits, risk of harm, uncertainties about and likelihood of success for each option, including the option to take no action

Training programmes

• If the patient does not wish to be involved in student training programmes, document this on consent form and in medical notes
• inform consultant responsible for care
• reassure patient that care is not compromised by this refusal

• Document discussion in case notes, including risks and benefits explained
• Fill in consent form and make additional notes in the medical records
• If patient satisfied with explanations given by you, fill in and sign part to be completed by doctor/dentist/healthcare professional
• If explanation was given by a colleague and patient is satisfied with explanation from that colleague, document name of doctor/dentist/healthcare professional who explained procedure
• to take consent, the colleague should be capable of undertaking the procedure
• A patient wishing to refuse some aspects of treatment or care must list procedures that s/he does not want to receive
• e.g. a Jehovah’s Witness refusing blood transfusion

• If patient agrees to procedure or operation with or without any documented refusals, s/he completes and signs ‘statement of the patient’ section of the form
• doctor/dentist/healthcare professional countersigns form, having given detailed explanation of consequences of any refusals
• make detailed record of this in patient’s medical notes
• Where a patient is unable to sign their name, a mark or sign made by the patient is adequate
• Where a patient is unable to physically sign a consent form but is able to express their wish, an advocate (nurse) may witness the process and sign the consent form to this effect

• Ensure all team members, including surgeon and anaesthetist performing procedure or operation, are fully aware of any refusals and are able to comply with patient’s wishes where there are practical matters to consider while performing the procedure or operation
• e.g. Jehovah’s Witness refusing blood transfusion/intra-operative cell salvage
• Give patient a copy of the consent form detailing nature, risks and benefits of procedure and patient leaflet where appropriate

• In an emergency, decisions may have to be made quickly
• less time to apply the guidance in detail, but the principles remain the same

Conscious patient

• Presume a conscious patient has capacity to make decisions and seek consent before providing treatment or care

Unconscious patient

• If the patient is unconscious or you otherwise conclude that they lack capacity and it is not possible to find out their wishes, you can provide treatment that is necessary to save their life or to prevent a serious deterioration of their condition
• If there is more than one option, provide the treatment which is least restrictive of the patient’s rights and freedom, including their future choices
• For as long as the patient lacks capacity, continue to provide ongoing care in line with the best interest principles