How much information should patients be given in order for the consent to be valid?
The amount of information doctors provide to each patient will vary according to factors such as the nature and severity of the condition, the complexity of the treatment, the risks associated with the treatment or procedure and the patient’s own wishes. The GMC counsels doctors to take appropriate steps to find out what patients want to know and ought to know about their condition and its treatment.
A careful balance needs to be struck between listening to what the patient wants and providing enough information in order that the patient’s decisions are informed (see also next question below).
The GMC provides helpful guidance on the type of information doctors should provide, such as:
- the purpose of the investigation or treatment
- details and uncertainties of the diagnosis
- options for treatment including the option not to treat
- explanation of the likely benefits and probabilities of success for each option
- the risks such as known possible side effects, complications and adverse outcomes including where intervention or treatment may fail to improve a condition
- the name of the doctor who will have overall responsibility; and
- a reminder that the patient can change his or her mind at any time.
The GMC also reminds doctors:
- to try to ascertain the patient’s individual needs and wishes
- not to exceed the scope of the authority given by the patient (except in an emergency where the patient’s views are not known)
- to raise with patients the possibility of additional problems coming to light during the procedure and discuss possible action in this event.
Doctors should respond honestly to direct questions from patients and, as far as possible, answer questions as fully as patients wish (see also Card 1 list: ‘Consent’ ). Failure to provide sufficient relevant information could be challenged in law, including under the Human Rights Act (see also Card 1 list: ‘HRA’).
Significantly, in 2015 a unanimous decision in the United Kingdom Supreme Court (Montgomery v Lanarkshire Health Board) made it clear that doctors must ensure their patients are aware of the risks of any treatments they offer and of the availability of any reasonable alternatives.
Although the person carrying out the procedure is ultimately responsible for ensuring that the patient has sufficient information to give valid consent, other members of the health care team have an important role in the provision of information and answering questions. Good quality information leaflets that patients can take away with them can also be a useful way of improving information provision but these should not be seen as an alternative to discussion.
What should be done when a patient asks the doctor to make the decision on his or her behalf?
Doctors should explain to patients the importance of knowing the options open to them and what the treatment will involve. If patients still insist they do not want to know in detail about their condition and its treatment, the doctor must still provide basic information about the treatment before proceeding. (See also Card 1 list: ‘Consent’.)
What should be done where a patient’s relative asks the doctor to withhold information from the patient?
Where the patient is competent, doctors should take the lead from the patient. The GMC counsels doctors to seek the views of the patient in such cases. It also reminds doctors that they should not withhold relevant information unless they consider that disclosure of this information would cause the patient serious harm. Although distress could constitute ‘harm’ to the patient in some circumstances, this is not generally accepted as sufficient reason to withhold relevant information.
Careful discussion will be needed if parents request that information is withheld from children. (See also Card 1 list: ‘Consent’, ‘0-18 years’, ‘Children’.)
If a patient gives consent for blood to be taken during an examination, is it necessary to specify what tests are to be performed?
Patients should be informed about the purpose of the tests and doctors should be prepared to respond to patients’ questions. If doctors need to take blood to test for evidence of a serious communicable disease, patients should be properly informed of the nature and implications of being tested, including the relative advantages and disadvantages, and their specific consent should be obtained. (See also Card 12 on Serious Communicable Diseases, and Card 1 list: ‘Consent’, ‘MET’.)
Card 3: Information provision