Ethics Armed forces doctor

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3. Consent and capacity

Key messages

  • Patient consent is required whenever a doctor wishes to examine or treat a patient.
  • Where a patient lacks capacity, treatment should be provided on the basis of his or her best interests.
  • Consent procedures should not be delegated to non-medically trained personnel.
  • Where there are language barriers, doctors may need to use non-verbal communication when communicating with patients.
  • Adult patients with capacity are entitled to refuse treatment and this right must be respected, even when doing so may result in permanent physical injury or death.

 

When is it necessary to seek patient consent?

...it is unlawful… to administer medical treatment to an adult, who is conscious and of sound mind, without his consent… Such a person is completely at liberty to decline to undergo treatment, even if the result of his doing so will be that he will die.  

Lord Keith in the case of Airedale NHS Trust v Bland

It is well-established in medical ethics and law that patient consent is required whenever a doctor wishes to examine or treat a patient. For consent to be valid the patient must have capacity, be informed and be consenting voluntarily.

 

Is consent required where a patient lacks capacity?

As in civilian practice, where a patient lacks capacity, treatment should be provided on the basis of what is in his or her best interests. Doctors should presume a patient has capacity to consent to treatment unless there is evidence to the contrary. An unconscious patient will clearly lack capacity to consent, whereas a severely wounded but conscious patient is likely to retain a degree of capacity and this capacity may fluctuate.

 

Does consent need to be sought for emergency treatment?

The nature of some emergencies means that the priority will be the swift provision of treatment in the patient’s best interests, rather than delaying vital treatment in order to obtain consent. While every effort should be made to obtain consent from patients who have capacity, as in civilian practice, there will be circumstances when it is not possible and the need to save life or avoid significant deterioration in the patient’s condition is paramount.

 

Case study: Obtaining valid consent to emergency treatment

In providing trauma care to a conscious civilian war wounded patient at a basic front line medical facility, you have no interpreter to facilitate your communication with the patient, who speaks no English and is frightened. The idea of valid, informed consent as an exchange of information between doctor and patient is of little or no help to you or the patient. Obtaining consent is a secondary consideration to doing whatever is necessary to stabilise the patient.

Does this mean that ethical considerations are irrelevant here?

Where it is not possible to wait for an interpreter in order to obtain consent without risking serious harm to the patient, the priority should be providing treatment to prevent such harm. In cases of genuine uncertainty, it is reasonable to assume that injured people will want to receive appropriate care and treatment.

Depending on the particular situation, doctors will need to consider and balance their duty to respect the individual’s right to consent and their duty to protect patients from harm. Patient consent involves treating patients as individuals and respecting their right to decide what is done to their body. These underlying ethical principles remain key, even where it is not possible or appropriate to obtain consent from a patient in an emergency situation.

 

Other aspects of consent

Read our guidance on communication

Read our guidance on refusal

 

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Ethical decision making for doctors in the armed forces tool kit (PDF)