Obtaining Consent

- in Osteopathic Practice -

Thanks for visiting this page - it's a great decision.  Getting consent right is absolutely fundamental in running an ethical practice, quite apart from keeping you away from the Professional Conduct Committee.

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It is a fundamental principle in healthcare that you must have valid consent to carry out an examination or treatment.  Failure to gain consent could lead action in the civil courts or through the GOsC.

You will often see the terms "Valid Consent" and "Informed Consent" used.  In theory, they have specific meanings, but as far as you are concerned the difference doesn't matter.  Your patient must be able to give consent (have "capacity") and must have been given sufficient information to make an informed decision.

It is presumed that an adult (ie over 18) or a young person (aged 16 or 17) has capacity to give consent, whereas children (under 16) are presumed not to be able to do so.  But these rules are not fixed: an adult with dementia, for example, might lack capacity and in some cases a child might be deemed to be "Gillick competent" - in other words having capacity.

If a child is not deemed Gillick competent, then an adult with parental responsibility must give consent.  Unless a court has ordered it, parental responsibility does NOT extend to anyone who is not a birth parent other than adoptive parents.  Step-parents, foster parents or grandparents, for example, cannot normally give consent to treatment.

In explaining the possible risks of treatment, you don't have to go to exhaustive lengths, but you must explain anything significant.

You have to do this in an objective way, without putting pressure on the patient to accept your recommendation, and you have make sure that they understand that no treatment is also an option.

Here are the 4 key factors in gaining consent:

  • The consent must be voluntary
  • The patient must have sufficient and balanced information to make the decision
  • They must be capable of using and evaluating the information
  • They must have the capacity to give consent
  • The patient must be aware that they can refuse

Can a patient decline to hear all this?  Well, yes, but you still have to give them basic information about what you intend to do ("I'd like to manipulate your lower back", for example).

Above all, the patient's consent must be recorded in your notes.

Consent does not have to be written, except in the case of intimate procedures.  In fact, because it is an ongoing process oral consent is probably preferable.

So, is a written consent form a good idea?  Possibly.  It at least shows that you have taken seriously your responsibility for informing the patient and is evidence that a consent process is in place.  But it does not mean that you can ignore the need to get permission throughout the appointment for each technique you want to perform, after all, a patient has the right to withdraw their consent at any time.

It's sensible to use the same, or similar, words every time when you ask for consent, and to record this in the same way in your notes (subject to any modifications you might make at the time).  Then, if you are ever unfortunate enough to appear in front of the Professional Conduct Committee, you'll be able to argue that you new what had taken place, because that's what you always do.

The documents attached here are all useful in helping to understand the issues around consent, and they don't take long to look over.  Sections 1-5 of the BMA document provide an excellent summary of the key points.

Whatever you do, don't overlook this vital element of care - you and your career could be at risk!