Empowering Patients About Surgical Consent: Understanding the Who, What, and How
May 4, 2020
Sometimes routine medical care unexpectedly becomes complicated by questions about surgical consent.
Updated December 2022
In this article, we thought the best way to answer the questions is by looking at different aspects of Surgical Consent:
It is the process of providing the information that enables the patient to make a decision to undergo a specific treatment. Consent should be considered informed decision making, or informed request. It requires time, patience and clarity of explanation.– Royal College of Surgeons, UK
This is the technical definition which means – obtaining a decision from a patient about a specific treatment after giving them enough information about the treatment to allow them to decide.
Even though we talk about ‘surgical’ consent, you will require consent for procedures that are not surgical in nature.
Scenarios Where You Require Consent
Pretty much any interaction with a medical practitioner involves your consent.
Examples may include:
In most routine encounters, your consent is taken as given when you willingly participate in discussions about your health.
But in each instance, every step taken to perform your assessment or examination needs your understanding and permission to continue.
Ideally, take everything into consideration when you are giving consent – it is not something you should rush into.
Consent requires the person who will perform the procedure to do the following:
Usually, it is best to provide these details and seek consent from you with your supporter present (if this is your wish).
You can give consent verbally or in writing.
Most often, you will give consent directly to the person carrying out the procedure or their representative.
For simple procedures, verbal consent is suitable.
These may be verbal consent for an X-ray, blood test or ear examination.
However, written consent is mandatory for surgical and intravenous treatments, e.g. with chemotherapy.
To give consent about a specific operation, you should be a “competent adult”.
A competent adult describes a person who is free of mental impairment (permanent or temporary).
It means you can make a reasonable and informed decision about your care.
In order to give consent, you will have detailed information about the procedure being planned.
Adult men and women can provide individual consent to their own treatment.
Parents and legal guardians of children aged under 16 years can legally provide consent for their children or wards.
Individuals with a Power of Attorney over another person can also provide consent on behalf of others.
Question – In some parts of the world, there is no health insurance or national health service. People pay for their own health care. So, let’s imagine a couple arriving at a private hospital. She is in advanced labour – the husband is the breadwinner, and his wife completely depends on him for financial support. He does not believe in anything but a natural birth, but it is soon clear that the woman will need a C-section. Can the husband insist she will not have the CS? Who should give consent? Herself or the person paying for her operation and hospital care?
*See below for the answer.
Being next of kin to someone else does not automatically mean you can provide consent on their behalf.
Who is the Next Of Kin?
This is the individual you identify as your closest living relative. – you being the person undergoing the procedure. In some countries, like the US, it is a legal entity with clear definitions, while in other countries, like the UK, it is not.
As next of kin, you may be given access to information about an individual’s health.
However, this does not mean you can give consent on their behalf.
On the other hand, if you have a ‘legal power of attorney’ for a person (such as a close relative), you can then provide consent on their behalf
Suppose a situation arises where an individual without legal power of attorney cannot provide consent. For example, they
Then the doctors caring for the individual will make decisions in their best interest.
Doctors may involve the next of kin or close friends in making decisions about an individual, and most times, all parties will agree on best interest matters.
If there are clear differences between the parties, it is time to involve the courts.
Your consent can only be to a specific procedure.
Ideally, your consent is written.
This means you sign a document stating what you understand and what your doctors explain about the operation.
Thus when you sign, you are indicating that you are granting ‘informed consent’ for it to go ahead.
Usually, you will give consent before the operation.
Most times, it may be at the stage where you are going through consultation and pre-assessment.
In cases of an emergency, there may only be enough time to provide brief explanations, especially if it is a lifesaving procedure.
In this case, the doctor will take the best interest decision unless there are pre-arranged legal directives for treatment or a power of attorney to provide consent.
A ‘best interest’ decision means that the doctors will select the option they consider is the best in your own interest/health.
No. You will give consent for one specific reason at a time.
Can you change your mind? Yes.
As long as you are mentally capable (competent) – anytime before the procedure, you can withdraw consent.
However, when you choose to withdraw consent, your doctor will record this in your medical notes.
They will state that they have explained the implications of withdrawing consent.
This is important – that you are aware of the implications of your choice.
If mentally capable, the woman who is going to undergo surgery should give consent. She can elect to have her husband present during the discussion before consent, but the decision (even if she is not paying for the cost of her care) is hers.
In many countries, the next of kin may be given the opportunity to provide consent for an unwell person.
But don’t assume!
Yes, as next of kin, you may have the right to certain information, but that may not give you the right to consent on their behalf.
Editing By AskAwayHealth
All AskAwayHealth articles are written by practising Medical Practitioners on various healthcare conditions to help promote quality healthcare.
The advice in our material is not meant to replace a qualified healthcare practitioner’s management of your specific condition.
To discuss your condition, please contact a health practitioner or reach us directly.
Image Credits – Canva
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