However, this comes with three caveats: It must be noted that, although much of the existing case law refers to doctors, the legal principles on informed consent apply in just the same way to nurses and all other health professionals (Young, 2009). Discuss why we have this doctrine and what would happen if we did not. The following post is on the importance of informed consent and medical ethics using examples from the history of gynecology and a more recent example: Gardasil Today, we all are aware of Margaret Atwood’s ‘The Handmaid’s Tale’. For the purpose of this article, person-centred care is defined as the “approach to care that places the person at the centre of their own care. Patients no longer have unquestioning faith in their doctors and nurses. 5+5 = The captcha value you provided is incorrect. This is the case of the law relating to consent to treatment. Sign in or Register a new account to join the discussion. Informed consent does not mean simply completing and signing a consent form. Box 1: The importance of informed consent Among the possible arguments for informed consent are: – That it safeguards patient autonomy. In the past, there was a paternalistic approach to healthcare: doctors decided not only what treatment would best fit their patients’ needs, but also what information to give to them. The NMC’s (2015) code of conduct sets out a mandatory framework of professional standards for practice. Why is it important? Get notified when a new post is published. We understand the importance of crafting tailored solutions to address your unique needs. 1. Review the case Informed Consent in Louisiana – Lugenbuhl v. Dowling. 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, 2014). The patient’s decision must be respected even if it is considered foolish, unfounded or irrational (Re T (Adult: Refusal of Medical Treatment) [1992] 4 All ER 649). It was thought that giving the patient too much information might “prejudice the attainment of the objective of restoring the patient’s health” and, therefore, conflict with the doctor’s duty to act in the patient’s best interests (Sidaway [1985]). Apex court of India in the case of Ms. Samira Kohli V/s Prabha Manchanda (2008) 2 SCC 1. To avoid further complications of Medcio-Legal cases, every Dr. should follow the Principles relating to consent as envisaged by Hon. Explain the meaning and importance of the doctrine of informed consent. If they are uncertain about any of this, they should seek advice. Informed consent is a process in which a patient gives consent to treatment after a healthcare provider discusses information related to the procedure so that the patient can make an educated decision whether to refuse or accept treatment (Hall, Prochazka, & Fink, 2012). In any medical setting, decisions are made often. It must also be noted that the law relating to consent in children is different to that for adults, and is not covered by this article. It follows, therefore, that the quality of the outcomes will depend on the quality of the information upon which decisions were based. The test to be applied is “whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it” (Montgomery [2015]). 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 concept of ‘person-centred care’ is widely cited in the literature and applied in nursing practice. As such, although patients had the right to access the information they needed to make a balanced decision (including any “general dangers and […] any special dangers […] without exaggeration or concealment”), doctors had the right to “decide what information should be given to the patient” and how that information should be presented (Sidaway [1985]). 4. What does it mean for practice? Nevertheless, compliance with legal and regula- tory requirements as well as ethical and patient family concerns can make the concept of informed consent baf- fling and challenging. We can see that this is important when it relates to ‘big’ things like operations, for which the patient needs to sign a form saying he or she gives informed consent. Author: Helen Taylor is visiting lecturer at the University of Birmingham and freelance writer on health law. It also continues to be a source of malpractice liability, because the legal requirements continue to lack complete clarity. From these, most of prospective clinical studies (87.5%) discussed informed consent. For UK health professionals only The roundtable discussion and this associated article…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. The Importance of Patient Informed Consent, learn more about medical malpractice insurance, The Importance of Patient Satisfaction in Healthcare, Importance of Doctor-Patient Communication. The Code of Ethics (American Nurses Association, 2010), contextualizes the nurse's call to advocacy within the doctrine of informed consent.This article offers a primer on the legal, ethical, and practical aspects of procedural informed consent and examines the value of nursing's role within the process. Practitioners will be deemed negligent if they fail to give patients the information they need to decide whether they want to accept the risks that a particular treatment may present (Montgomery [2015]). This type of consent applies to many situations in life, including making decisions about medical care and legal issues, as well as entering into contracts. When this case was first heard, the Scottish Court of Session followed the approach taken in Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital [1985] AC 871 and concluded there was insufficient risk of significant harm to Mrs Montgomery to warrant a warning. Nurses should be aware that they will be accountable for the decisions they make about disclosure, and should ensure that they carefully record the decision-making process and the information shared. Oxygen deprivation during birth resulted in severe and permanent disability for Mrs Montgomery’s son. Before making a decision about medical treatment, it is a good idea to get information about the treatment and give yourself time to consider it. 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, 2017). Compliance with “the professional standards that registered nurses and midwives must uphold [is] not negotiable or discretionary” (NMC, 2015). Box 1. Many times Doctors do not pay importance to this fundamental aspect. Did you know that there was a time when slaves were used similarly for reproduction and reproductive studies … Chester v Afshar [2004] does not specify the extent of the information doctors must provide, other than saying there is a “legal duty to a patient to warn him or her in general terms of possible serious risks involved in the procedure”. It may not provide a valid legal defence if, for example, the patient felt obliged or was persuaded by others to accept treatment. Although the case refers specifically to surgical interventions, more recent cases such as Gallardo v Imperial College Healthcare NHS Trust [2017] EWHC 3147 (QB) show that the principle applies to treatment more generally. It is the ethical principle known as respect for persons. The Society of the New York Hospital case. The obstetrician felt the risk to Mrs Montgomery and her baby was relatively small, and did not warrant the elective Caesarean section that she would be likely to request if told of the risk. This is important since even treatments which are meant to help a patient come with risks, and it is essential for patients to accept those risks when getting care. 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. 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 provisio… No one can guarantee positive outcomes in healthcare settings, but informed consent at least ensures patients understand the risks they undertake with treatment. This could simply mean following their suggestions, such as the doctor asking you if they can take your blood pressure and you … Gallagher Healthcare is one of the largest advisors to physicians and surgeons when it comes to medical malpractice coverage. So, informed consent is very important to protect patient ’s right and nurses are in an ideal place to play the advocacy role in different ways such as, a defender of patient’s right,.Johnston, M.J., (2009), also reemphasized the advocacy role of nurses and moral purpose of informed consent is to protect patients from the harm and to improve quality of life. Consent is a process, not a form. Research professionals, including research nurses, who seek informed consent are expected to convey information in a clear and unambiguous way, adapting “the presentation of the information to the subject’s capacities” (National Commission, 1979, Part C, para. Argument. This means nurses must “get properly informed consent and document it before carrying out any action”. Nursing professionals in a variety of practice settings routinely use implied consent. Informed Consent is still an issue on the healthcare agenda. Patients are now more aware of their treatment options, more aware of their rights as consumers of healthcare, and prepared not only to complain about care they consider substandard but also to take legal action (McCrae, 2013). Although the term may be used interchangeably with ‘patient-centred care’ (Perez-Merino, 2014; McCrae, 2013), there is some variance in how it is defined in the literature. Nurses must generally obtain the patient’s informed consent before proceeding with treatment, Proceeding with treatment without the patient’s consent is, in most cases, unlawful, The law on informed consent in adults was changed by a judgement of the Supreme Court in 2015 (Montgomery v Lanarkshire), Nurses must provide patients with the information they need to make an informed decision about their care, If the necessary information to make an informed decision is not given, consent may not be valid and nurses may be acting unlawfully if they proceed with treatment. Informed consent creates trust between doctor and patient by ensuring good understanding. This applies to all areas of life, including healthcare (Re F (Mental Patient: Sterilisation) [1990] 2 AC 1) and means patients generally have the right to make decisions about their care – for example, whether to accept a treatment or intervention – even if their “refusal may risk permanent injury to [their] health or even lead to premature death”. The obstetrician recognised there was a 9-10% risk of shoulder dystocia that would complicate the delivery, but decided not to share that information with Mrs Montgomery. Consent may be given orally, or it may be implied - as when a patient rolls up their sleeve and offers their arm so you can take their blood pressure.For more complicated procedures, you must obtain the patient's express consent, and this will usually be in writing, by signing a consent form. We can help you learn more about medical malpractice insurance, and our team of professionals can review your needs, so we can bring you multiple policy options. This meant doctors were able to withhold information from their patients and would not be deemed negligent provided they had “acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art” (Bolam v Friern Management Committee [1957] 2 All ER 118). Nursing Standard. The requirement for nurses to obtain consent prior to nursing care procedures is addressed in various nursing policy documents. Nursing Times [online]; 114: 6, 25-28. In turn, patients must evaluate what they hear and make decisions about whether to pursue a specific course of treatment, seek a second opinion or refuse a suggested procedure. Nurses know they must have their patients’ informed consent before giving any form of care or treatment but they may not be fully aware of the legal basis behind this and the implications of not doing so. Individuals are supported, facilitated and enabled to contribute to their care through shared decision making, equality of communication and mutual respect” (Mitchell and Agnelli, 2015). The study on knowledge of informed consent and importance to nursing practice is limited to nursing students. 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, 2005). This is one of the main reasons why patient consent, also known as informed consent, is so important. 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. Consent from a patient is needed regardless of the procedure, whether it's a physical examination, organ donation or something else. Request a quote today to see how Gallagher Healthcare can work to bring you affordable coverage. Health professionals need to give patients sufficient information to make an informed decision, but what does this mean in practice? The Montgomery case: implications for practice. What can nurses do to improve informed consent? Think about consent as a process to assure patient understanding and agreement, not just signing a form. 3. The second article in this series will consider what makes consent valid and explains that this may depend on the circumstances in which care is planned. It is vital that you give the patient all the information they need about the procedure and clearly document the information you have given the patient in their notes. If there is doubt as to whether consent was sufficiently informed, a decision will be made by the court (Montgomery v Lanarkshire Health Board [2015] UKSC 11; Chester v Afshar [2004]). First, identify the elements of the legal citation- plaintiff, defendant, court, location of case etc. Tagged with: Coronavirus zone: legal and professional issues Newly qualified nurses: legal and ethical issues. The Code emphasises the need for nurses to “keep to all relevant laws about mental capacity that apply in the country in which [they] are practising, and make sure that the rights and best interests of those who lack capacity are still at the centre of the decision-making process”. "Informed Consent" in Medical Treatment is of Utmost Importance, !!!! Although healthcare providers have a legal obligation to provide treatment for their patients and may incur liability in civil law (negligence) or even criminal law if they fail to do so, they may also be liable if treatment is given without the patient’s consent. The concept is not explained in the NMC Code, but the doctrine of informed consent as a principle in English law was clearly established in Chester v Afshar [2004] UKHL 41. Doctors need to reach a diagnosis, then decide which treatment makes the most sense based on a patient’s needs. It will also discuss situations in which treatments and interventions may be given lawfully in the absence of consent. What is informed consent? With informed consent, a patient can consent to treatment that they understand. The physician should have obtained consent before the nurse has the patient sign a form. Shoulder dystocia occurred and made vaginal delivery impossible, so an emergency Caesarean section had to be performed. The act of securing an informed consent is to protect clients’ rights which resemble the ethical principle of autonomy and avoid any legal ramification to the nurse (Wilhite, 2010). To recognise and uphold their patients’ rights, nurses must not only be aware of the standards set out in the Code, but also understand their legal basis. In that case, the House of Lords made clear that a practitioner would be negligent – and in breach of their duty of care to the patient – if they failed to advise them of the risks associated with a proposed treatment. The consenter must have the necessary mental competency to consent The consenter must be informed To be genuine and voluntary, consent should be obtained without coercion, threat, or undue influence and without the influence of drugs or alcohol. © Copyright 2015 by Arthur J. Gallagher & Co. All Rights Reserved. Informed consent is the patient’s agreement to permit healthcare providers to perform any invasive procedures or medical surgeries in awareness of the risks, benefits, alternatives treatment and consequences of refusing consent (Black, 2004). Citation: Taylor H (2018) Informed consent 1: legal basis and implications for practice. The NMC Code expands on this by stating that nurses must ensure that they “get properly informed consent and document it before carrying out any action” (NMC, 2015). Evidence-based practice is considered fundamental to the delivery of good-quality person-centred care (Banner et al, 2016). Nurses will be acting unlawfully, and contrary to the principles of person-centred care if they administer care without a patient’s consent. Treatment makes the most sense based on a patient ’ s needs may strive to ensure they obtain informed.. Based on a patient ’ s son these decisions are made quickly if is... By Arthur J. Gallagher & Co. 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