What does consent really mean?
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. This could simply mean following their suggestions, such as your doctor asking to have a look at your throat and you showing your consent by opening your mouth. Sometimes they will ask you to sign a form, depending on the seriousness of what they’re proposing or whether it carries risks as well as benefits.
It does not matter so much how you show your consent: whether you sign or say you agree. What is important is that your consent is genuine or valid.
That means:
- You must be able to give your consent
- You must be given enough information to enable you to make a decision
- You must be acting under your own free will and not, say, under the strong influence of another person
English law assumes that if you’re an adult you are able to make your own decisions, unless it’s proved otherwise. As long as you can understand and weigh up the information you need to make the decision you should be able to make it.
Consent for children
You can always give consent to being examined or treated in the same way as adults can if you’re between 16-18 years of age. However if you decide to refuse a particular treatment sometimes your parents may get involved.
Children who are under 16 years of age can also consent to their own treatment if it is thought that they have sufficient intelligence, competence and understanding to fully appreciate what is involved in their treatment.
If a child who is under 16, or a teenager who is 16 or 17 years old, refuses treatment and by doing so this may lead to their death or a severe permanent injury, their decision can be overruled by the courts. The court used is the Court of Protection, which is the legal body that oversees the operation of the Mental Capacity Act (2005).
In some cases, the parents of a child who has refused treatment have been allowed to consent for them. However, it may be best to go through the courts in such situations.
What do you need to know before giving consent?
In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you don’t understand or if you want more information.
For example:
- What sort of things will the treatment involve?
- What are the benefits they hope will result?
- How good are the chances of getting such benefits?
- Are there any alternatives?
- What are the risks, if any?
- If there are risks, are they minor or serious?
- What may happen if you don’t have treatment?
If the person asking for you to give consent to the treatment isn’t able to answer your questions, ask them to find out or arrange for someone else to talk to you about your concerns.
How much time can I take to decide?
Your doctor, nurse or therapist may certainly encourage you to accept a particular treatment if they believe it will be helpful for you, but it is your decision whether or not to go ahead. If you want more time to think about your decision, say so. In emergencies, decisions may have to be taken quickly, but at other times it is often possible to take as much time as you need.
Can I refuse treatment in advance?
You may be quite certain that you would not want a particular treatment in the future. In that case you may like to make a written record of your wishes (a document sometimes called a Living Will), and make sure people close to you know. Then if this situation arises at some point in the future and you are not in a position to tell your wishes to people providing healthcare, they will be bound by your earlier decision.
It is important to be very precise about any treatment you are refusing in advance; otherwise you could exclude treatments which you would want to accept. It is also important to let people close to you know if you have changed your mind so they can pass on this information if necessary.
What if I’m asked to take part in research?
This may be as part of your treatment, for example to compare two different treatments; or it may be quite separate, for example being asked to provide extra blood samples for a research project. In any case, a research project will always be approved by a Research Ethics Committee before you are asked to take part in it.
It is for you to decide whether or not to take part. You should usually be given an information sheet about the research project, and you should ask as many additional questions as you want before coming to a decision. If you choose not to take part in a research project, and then change your mind, you are free to withdraw at any time.
Are there any advantages or disadvantages to taking part in research?
Sometimes you may only be able to get particular treatments as part of a research trial. This is because they are new and cannot be made generally available until they have been properly tested. If the person responsible for your care suggests that you might benefit from being in the trial, ask as many questions as you want:
- About the new treatment
- About any risks
- And about the alternatives to being involved
There is a type of research in which neither you nor your doctor will know whether you are being given the new treatment, the standard treatment or possibly any treatment at all (you will always be told what options are being used in the research project, even though you will not know which option you will receive.)
If you are not happy about being involved in this or indeed in any kind of trial, you should feel free to say so. You will always be able to have the available standard treatment. All treatments, even established ones, have risks and these have to be weighed up when making your decision.
Suppose I’m not happy about the way I have been approached about consent?
You can tell the healthcare professionals concerned that you are worried. But if you are still not satisfied, you are entitled to complain. Please ask for a copy of our ‘We Value Your Opinion’ leaflet.
Further Information
Department of Health Publications
PO Box 777
London SE1 6XH
www.doh.gov.uk
The Patients Association
PO Box 935
Harrow
Middlesex HA1 3YJ
Helpline: 08456084455
www.patients-association.com
Patient Concern
PO Box 23732
London
SW5 9FY
Tel: 020 7373 0794
www.patientconcern.org
