Author: Helen Taylor is visiting lecturer at the University of Birmingham and freelance writer on health law. What is informed consent? Why is it important? What does it mean for practice?
This article — the first in a two-part series — explores the legal principles of informed consent in adults, considers why it is fundamental to the provision of person-centred care, and explains how the law relating to informed consent has recently changed. Nurses make many clinical judgements and decisions throughout the course of their working day. The process of clinical decision making has been widely explored and can be explained in a number of ways, ranging from the intuitive to the analytical Taylor, ; Thompson and Dowding, ; Hamm, Regardless of the process used, the consensus is that decisions will be based on information of one kind or another, and will influence the outcomes for patients Taylor, It follows, therefore, that the quality of the outcomes will depend on the quality of the information upon which decisions were based.
Evidence-based practice is considered fundamental to the delivery of good-quality person-centred care Banner et al, Sometimes person-centred care is not defined but, instead, is simply described in terms of patient autonomy, holistic care and primacy of patient need Hayes, Person-centred care implies the centrality of the patient, who is seen as a key participant in care, rather than the passive recipient of it.
All registered nurses, registered midwives, student nurses and student midwifes are accountable for their practice and must comply with the Code to ensure their practice meets the standards required not only by the NMC, but also by patients and the general public.
Nurses will be accountable for any deviation from these principles and must be able to justify their actions Cornock, If they base their decisions on the best available evidence, they will be able to inform, explain and account for these decisions Aveyard and Sharp, Arguably, as well as informing the clinical element of care for example, selecting the most appropriate wound dressing , the best available evidence must also inform the wider framework for decision making for example, determining the legality of providing treatment if the patient is unconscious and, as such, not able to give their consent.
There is a legal principle that ignorance is not a defence: if a law is not known or not understood, this does not remove any liability that comes with it. However, although nurses may be aware of broad legal concepts set out in the Code, they do not always understand the detail of the law and how it affects their practice Taylor, This means that, beyond the potential negative impact on patient care, they may be in breach of the law without knowing it.
As well as understanding the legal framework that underpins care, nurses need to be aware that the law can change quickly, even after long periods without changes. This is the case of the law relating to consent to treatment. It is useful to start by considering consent from an ethical perspective and how it relates to the principle of autonomy. This principle is upheld in the law, which recognises that all adults generally have a presumed right to decide what happens to their body.
The law not only protects a person from any unwanted touch, but also from the fear of being touched. It is unlawful to touch another person unless they have agreed to it; their consent makes lawful an act that would otherwise be unlawful Taylor, , as highlighted in Collins v Wilcock [] 3 All ER British Medical Association Consent Toolkit. London: BMA. London: DH. Family Law Reform Act c London: GMC.
Mackay J ed Criminal Law. Mental Capacity Act c9. Offences Against the Person Act c. Sign in or Register a new account to join the discussion. You are here: Patient safety. What does consent mean in clinical practice? Abstract Nurses need to be aware of the importance of patient consent in relation to issues such as confidentiality or research participation.
This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF, including any tables and figures. Box 1. Key issues in adult consent All adults have the right to make their own decisions and must be assumed to have capacity to make them unless it is proved otherwise Adults must be given all practicable help before they are treated as being unable to make their own decisions Adults should not be treated as lacking capacity just because they make what might be seen as an unwise decision The courts may decide that consent is not valid if it is given under duress or undue influence, or if the adult lacks capacity Re T Adult: Refusal of Treatment [] Fam Key points Every adult must be assumed to have capacity to make decisions unless it is proved otherwise Practitioners must obtain consent to treatment even in an emergency If health professionals carry out a procedure without valid consent, they may be liable Patients must understand the consequences of planned procedures to give valid consent Medical treatment is not generally subject to criminal liability because their ultimate aim is to benefit the patient.
R v Hogan [] 2 All ER. R v Senior [] 1 QB Related files. Did you use your office [ We understand, professional liability insurance isn't the most exciting thing to learn about, but it's important.
It's important to you [ Toggle navigation. Nancy Brent Nancy J. Mental Health. The components of informed consent include the person's knowledgeable consent to a treatment or procedure after they have been given, and understand, complete, unbiased information about:.
Again, all clients have the legal right to autonomy and self-determination to accept or reject all treatments, procedures, and interventions without any coercion or the undue influence of others.
The physician, or other licensed independent providers, the nurse and the client have roles and responsibilities in terms of informed consent. The nurse is responsible and accountable for the verification of and witnessing that the patient or the legal representative has signed the consent document in their presence and that the patient, or the legal representative, is of legal age and competent to provide consent.
They also confirm that the patient has sufficient knowledge to make a knowledgeable decision. The physician, or another licensed independent practitioner such as a nurse practitioner or a physician's assistant, provides the client with complete information about the treatment or procedure, the potential risks including pain and complications, the benefits of the treatment or procedure, who will perform the planned treatment or procedure, and any possible alternatives to the treatment or procedure including their benefits and risks.
The patient or their legal representative must give consent voluntarily and without any coercion by others.
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