Who can give (Surgical) Consent?
Sometimes routine medical care unexpectedly becomes complicated by the question – “Who can give surgical consent”?
Updated March 2022
In this article, we thought the best way to answer the question is by looking at different aspects of Surgical Consent:
- What is it;
- who gives it and
On This Page
- What is Surgical Consent?
What is 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.
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:
- Prior to an intimate examination like a vaginal or rectal examination;
- Before receiving an injection for treatment
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.
What is Involved in Consent?
Consent requires the person who will perform the procedure to do the following:
- Check if you have a supporter, such as a friend or next of kin whom you wish to be present during the discussion.
- Provide details about your diagnosis, and all treatment options.
- Treatment options include the procedure or alternatives as well as non-surgical methods and no treatment.
- They will also talk about the prognosis – that is, how your illness may progress without treatment.
- Next, they will explain the procedure they intend to perform.
- This means doing so in the most basic terms, using simple non-medical language, providing clarifications when necessary and allowing you ask questions.
- Explain the purpose of the procedure – to cure or to manage symptoms.
- This will include outlining details of the possible risks that may arise from the procedure.
- The doctor will also discuss the success rate of the procedure.
- After all this, your doctor will check that you fully understand the explanations.
Usually, it is best to provide these details and seek consent from you with your supporter present, (if this is your wish).
How is Consent Given?
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, or blood test or ear examination.
However, for surgical treatments, intravenous treatments eg with chemotherapy; written consent is mandatory.
Who Should Give Consent?
To give consent about a specific operation, you should be a “competent adult”.
A competent adult simply 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 are also able to provide consent on behalf of other people.
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 arrives at a private hospital, she is in advanced labour – the husband is the breadwinner and his wife is completely dependent 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.
And Who Should/Can NOT Give Consent?
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
If an individual without a legal power of attorney is unable to provide consent; for example they
- are too ill
- are unconscious
- do not have capacity;
then the doctors who are caring for the individual will make decisions in their own 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.
What are You Consenting To?
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.
When Should You Give Consent?
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.
Does Consent for One Thing mean Consent for All?
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 for withdrawing consent.
This is important – that you are aware of the implications for your choice.
Can a Man Give Consent for a C-section on Behalf of His Wife?
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 a person who is unwell.
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 a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly.
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