Consent must be valid
, which means
- given voluntarily
- given by a competent person
whereas a competent person is defined by
- the ability to understand and remember the given information
- the ability to weigh up risks and benefits of the procedure
- the consequences of not having the procedure
- appropriate information is provided (nature + purpose of the procedure, pan relief, complications/risks, alternative treatment options)
- explanation of common risks (e.g. nausea) and also severe complications even if they are rare (e.g. nerve injury)
- patients individual experience and background are taken into account (e.g. values, social background, culture, religion, beliefs, intellect)
- documentation of the agreed anaesthetic and post-operative plan including a list of risks explained
- separate anaesthetic consent forms are currently not necessary (some departments make use of them)
Consent - special situations:
1. Refusal of treatment
- a well-informed patient with capacity can voluntarily refuse treatment (even when this results in death)
- this has to be accepted by the health care professional
2. Advanced directive
- refusal of treatment in advance in case of future incapacity
- written "living will" by a competent person
- are legally binding
3. Young adults (>16 years)
- can give consent without separate consent from a parent or guardian
Young adults (<16 years)
- can be competent to give consent (if able to understand the information provided and to outweigh risks & benefits)
- children and young adults who refuse treatment can be overridden by a parent or court
- the treatment has to be in the childs best interest
- parents can consent for children without capacity
4. In an emergency
- verbal consent by telephone is adequate
- consent is not necessary in life-threatening situations
- if a child or parent refuse treatment a court order can be obtained (but that should not delay emergency treatment)
5. In unconscious patients
- essential treatment is possible without consent
- it is good medical practice to inform the next of kin
- the next of kin can not give or refuse treatment
6. Restricted consent:
- certain aspects of treatment may be refused (e.g. blood transfusion in Jehova's Whitnesses)
- must be discussed with patients in detail so that the patient understands the consequences of refusal
- must be respected at all times
- the patient can change this decision at any time
7. Research / Teaching
- the same legal principles apply as for giving consent