Dr.Anna Stienen-Durand ST3 O&G, RSCH 29.9.14 Consent in O&G Dr.Anna Stienen-Durand ST3 O&G, RSCH 29.9.14

When Do I Need to Obtain Consent? Before you examine or treat any competent adult patient Consent can be withdrawn at any time

Seeking Valid Consent Are you performing the procedure? Are you capable of performing the procedure? Have you been specially trained to seek consent for this procedure? The patient should be informed of: alternative treatments benefits, risks and potential complications The patient should be competent Consent must be given voluntarily

How Do I Obtain Consent? Is my patient able to make an informed judgement? Do they understand the condition and prognosis? Discuss significant risks and unavoidable risks Any alternatives to the procedure? The risks of not performing the procedure Additional procedures Document this information

The Consent Form Proposed procedure with possible other procedures Intended benefits Serious risks Frequent risks Extra procedures which may become necessary

Duration of Consent Valid indefinitely unless it is withdrawn Can be withdrawn at any time Reconfirm consent if: There is new information regarding the proposed intervention Your patient’s condition has changed significantly Obtained a significant time before proposed intervention

Refusal of Treatment If a patient is deemed competent they are entitled to refuse treatment even where it would clearly benefit their health A competent pregnant patient has the right to refuse any treatment even if this is detrimental to their foetus Exception: where the treatment is for a psychiatric illness and the patient is detained under the Mental Health Act 1983

In an Emergency What to do in an emergency? Provide medical treatment ensuring the treatment must be limited to what is immediately necessary to save life or avoid significant deterioration in the patient's health You should tell the patient what has been done, and why, as soon as they are sufficiently recovered to understand Where consent cannot be obtained, you may provide Advance directive

Patients Who Lack Capacity If patients lack capacity you may carry out an investigation or treatment that you judge to be in their best interests provided they comply You should seek the courts' approval for any treatments which are not directed at their psychiatric disorder

Gillick Competence Gillick competence: children under 16 who have sufficient understanding and intelligence to enable them to understand fully what is involved in a proposed intervention also have the capacity to consent to that intervention Additional consent is not required if voluntary consent provided by the minor

Non Gillick Competent Children Where a child under the age of 16 is not Gillick competent consent can be given on their behalf by any one person with parental responsibility or by the court Children born after 2003: both biological parents if registered on the birth certificate Children born before 2003: both biological parents if they were married at or around the time of the child’s conception If parents never married father may acquire parental responsibility by order or agreement

Summary Seeking valid consent The consent form Refusal of treatment Capacity Gillick competence and treatment of minors Recommended top read: RCOG consent forms