1. Consent Dr Lisa Joels MD FRCOG Royal Devon &Exeter NHS Trust November 2011 © Royal College of Obstetricians and Gynaecologists

2. Consent Fully informed consent The Mental Capacity Act Consent relating to family planning issues

3. Consent – legal issues English civil law – deliberately touching another person without their consent is battery Civil action for negligence for not receiving enough information about a procedure – especially related to risk

4. Types of consent Tacit – e.g. You tell a patient you want to take a blood test and she holds out her arm and stays still Verbal – E.g. You ask if you can do a vaginal examination and she says yes Written – For all invasive procedures, those involving risk and those needing anaethesia

5. Principles of consent That it is fully informed That it is taken at an appropriate time That respect is paid to the patient’s dignity & beliefs That it is freely given without coercion That the person has capacity to consent

6. Fully informed consent You must ensure that she understands: – The nature of the condition for which the procedure is proposed – The nature of the intervention or procedure – The intended benefits and likely outcome – The risks of the procedure – Alternative treatments – The risk of not having the procedure Document any procedures she would not agree to have

7. Good medical practice Courtesy, respect for dignity and beliefs An appropriate time – “cooling off” period Appropriate language – Clear, simple language – Avoid medical jargon – Use examples

8. Expressing frequency Very common 1/1 to 1/100 A person in family Common 1/10 to 1/100 A person in street Uncommon 1/100 to 1/1000 A person in village Rare 1/1000 to 1/10,000 A person in small town Very rareLess than 1/10 000 A person in large town

9. Consent freely given Try to ensure that patient is free to express her own free will – Avoid using family members as interpreters – Try to see woman on her own to explore her true feelings

10. Specific issues Screening Sterilisation Fertility treatment – HFE Act 1990 & Code of Practice Consent in labour if distressed, in pain or had opiate analgesics Students Human Tissue Act – Retention and disposal of human/fetal tissue Multimedia

11. Capacity to consent The patient must be able to: – Understand information – Retain information long enough to make decision – Weigh up available information – Communicate their decision Must provide information in a way the patient can understand – Braille, sign language, interpreters, simple language

12. Mental Capacity Act 2005 5 key principles – Presumption of capacity – Every effort must be made to support the patient making their own decisions – Right to make own (even unwise) decisions – Best interests – Least restrictive of human rights

13. Mental Capacity Act 2005 Lasting Powers of Attorney – The patient makes a legal declaration while they have capacity nominating the person who will make decisions on their behalf when they lack capacity Independent Mental Capacity Advocate – Appointed by courts to act in the patient’s best interests

14. Girls under 16 years old Fraser competency – Girls aged 12 -16 years may be able to consent without parental knowledge, e.g. for contraceptive or termination services, providing they have capacity – Able to understand the options and implications of their decision – Able to weigh up the information and make a decision

15. Four consent forms Form 1 – Consent by the patient – general or local anaesthetic Form 2 – Consent by parent for child under 16 Form 3 – Consent by patient/parent where no anaesthetic needed (optional) Form 4 – Consent for adult without capacity to consent

16. The exam Consent may come up written or OSCE exam – Counselling a patient – Awareness of need to see patient on her own – Specific items to discuss in consent for sterilisation – Consent in girls under 16 requesting contraceptive or termination services

17. Further reading www.rcog.org.uk – Consent series: specific guidance about key obstetric and gynaecological procedures Clinical Governance Advice 6 – Obtaining valid consent (Dec 2008) Mental Capacity Act 2005 General Medical Council British Medical Association