Patients no longer have unquestioning faith in their doctors and nurses. Mrs Montgomery went into labour. It is also the law. 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’. If they are uncertain about any of this, they should seek advice. The requirement for nurses to obtain consent prior to nursing care procedures is addressed in various nursing policy documents. The Importance of Patient Informed Consent, learn more about medical malpractice insurance, The Importance of Patient Satisfaction in Healthcare, Importance of Doctor-Patient Communication. Informed consent is when a healthcare provider — like a doctor, nurse, or other healthcare professional — explains a medical treatment to a patient before the patient agrees to it. It also reduces the risk for both patient and doctor. The courts considered that patients needed to be protected from making irrational decisions so the House of Lords extended the Bolam test – used to assess negligence – to the information doctors were required to give or disclose to patients. Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination. 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). 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. 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. 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 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. 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). Informed consent is based upon the ethical principle of autonomy. From these, most of prospective clinical studies (87.5%) discussed informed consent. 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]). Explain the meaning and importance of the doctrine of informed consent. 5. 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. Generally, patients are no longer passive recipients but, rather, active partners in their care. 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. This remained the law until 2015, when a landmark judgement was made by the Supreme Court in the Montgomery [2015] case, which is described in Box 2. 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). 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, 2013), as highlighted in Collins v Wilcock [1984] 3 All ER374. 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. Mrs Montgomery, who had type 1 diabetes, was expecting her first baby; a pre-natal assessment indicated that the baby would be large. It is the ethical principle known as respect for persons. The physician should have obtained consent before the nurse has the patient sign a form. This material should be presented in a way that is easy for them to understand. 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. This means nurses must “get properly informed consent and document it before carrying out any action”. Nurses can offer what we do best—patient … 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). 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. Consent must be voluntary. NURSE’S ROLE IN INFORMED CONSENT Nurses may strive to ensure patient autonomy and rights throughappropriateparticipationintheinformedconsent process. What is informed consent? 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. It is important that nurses understand the legal and ethical rationale behind the principles of informed consent so that the principles are applied appropriately to the particular context of nursing care. 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. Nursing Children and Young People. Informed consent can also mean patients are informed if treatment is recommended, as well as what might happen if they get no treatment. 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. Only half of those (52.9%) reported that written informed consent had been obtained; few (3.6%) reported oral consent, and few (6.8%) used other methods such as online consent or completion and return of data collection (such as surveys) to denote assent. This principle is upheld in the law, which recognises that all adults generally have a presumed right to decide what happens to their body. This could simply mean following their suggestions, such as the doctor asking you if they can take your blood pressure and you … 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). Some patients may be particularly vulnerable to pressure from others so nurses need to be alert to the possibility of coercion and make every effort to ensure patients are supported to reach their own decision (General Medical Council, 2008). 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. ‘Employers must do their utmost to support their nursing staff’, The law on informed consent in adults has recently changed. With informed consent, a patient can consent to treatment that they understand. It also reduces the risk for both patient and doctor. Author: Helen Taylor is visiting lecturer at the University of Birmingham and freelance writer on health law. The Montgomery case: implications for practice. The captcha value you provided is incorrect. 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. Apex court of India in the case of Ms. Samira Kohli V/s Prabha Manchanda (2008) 2 SCC 1. 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). 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. The section will also look at consent, which is all about ensuring we have permission from patients/clients to carry out tasks with, for and on them, and capacity, which relates to a person’s ability to use and understand information to make a decision and either offer or refuse consent. Some of the key legal principles of the NMC Code are highlighted in Box 1. 8) and ensuring its comprehension (Federal Register, 2017). – That it is a requirement of justice, understood in terms of patient empowerment. Informed consent should be a collaborative activity between the physician, nurse, and patient. This article, the first of two on informed consent, explains how the law has evolved and how it applies to nursing practice. Nurses will be acting unlawfully, and contrary to the principles of person-centred care if they administer care without a patient’s consent. Informed consent seeks to incorporate the rights of autonomous individuals through self-determination.It also seeks to prevent assaults on the integrity of the patient and protect personal liberty and veracity. Argument. In civil cases, the claimant (usually the patie… 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. Although not all patients want, or are able to, participate in decision making, there has been a shift towards the active involvement of patients in this area. The health professional would be found negligent if they have not given the patient enough information to make an informed decision. 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, 2016). As such, nurses must ensure their decisions are based on “the best evidence available” (Nursing and Midwifery Council, 2015). To avoid further complications of Medcio-Legal cases, every Dr. should follow the Principles relating to consent as envisaged by Hon. By ‘informed’ we mean that the patient/client understands exactly what is going to happen because you or a senior colleague have explained it in a way that he or she can easily understand. Informed consent does not mean simply completing and signing a consent form. 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. 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. 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. 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]). Doctors need to reach a diagnosis, then decide which treatment makes the most sense based on a patient’s needs. Autonomy recognises an individual’s right to make choices on matters relating to themselves, unrestricted by factors – such as controls imposed by others or lack of information – that would limit the freedom of their choice (Beauchamp and Childress, 2012). Compliance with “the professional standards that registered nurses and midwives must uphold [is] not negotiable or discretionary” (NMC, 2015). Informed consent alone is not enough. When people are invited to take part, they should be given a verbal explanation of the study, including details such as its 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. That full knowledge and understanding is the necessary factor in whether an individual can give informed consent. This may mean a physician explains the possible side effects, risks and benefits of a course of treatment or informs a patient of what other treatments may be available. © Copyright 2015 by Arthur J. Gallagher & Co. All Rights Reserved. Health professionals need to give patients sufficient information to make an informed decision, but what does this mean in practice? It is useful to start by considering consent from an ethical perspective and how it relates to the principle of autonomy. 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. Influence of consent to the nursing The NMC Code Conduct states nurses must advocate people's rights to be fully involved in decisions about their care. 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. It may not provide a valid legal defence if, for example, the patient felt obliged or was persuaded by others to accept treatment. During the later stages of her pregnancy, she told her obstetrician about her concerns that the baby’s size would make delivery difficult. This means medical professionals must offer enough information to patients to enable them to make a choice and provide enough time, where possible, so patients don’t feel pressured. What does it mean for practice? Informed consent means patients receive enough information to make an educated decision about their treatment. What is informed consent? Informed Consent is still an issue on the healthcare agenda. Oxygen deprivation during birth resulted in severe and permanent disability for Mrs Montgomery’s son. First, identify the elements of the legal citation- plaintiff, defendant, court, location of case etc. Other than in exceptional circumstances, nurses have both a legal and a professional obligation to ensure: Consent will only be valid if that information has been given. 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. Our expert agents negotiate pricing and compare medical malpractice insurance solutions with all major A-rated carriers and alternative markets on your behalf, providing you with the best possible option available in the insurance marketplace. Patients would be spared information which their doctor thought they might find upsetting or otherwise did not need to know – for example, a diagnosis of cancer or terminal illness (McCrae, 2013). It also continues to be a source of malpractice liability, because the legal requirements continue to lack complete clarity. Box 3. They assess patients’ health status and plan care based on their observations, deciding which treatments and interventions best meet patients’ needs. 29, 10, 45-48. doi: 10.7748/ns.29.10.45.e9443 In situations where the issue of consent has been questioned, a successful legal action requires proof that consent was not given. What is informed consent? It is the process of participants learning the facts about a clinical trial before deciding whether to take part. 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. Nursing Standard. 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, 2005; Thompson and Dowding, 2001; Hamm, 1988). Why is it important? In Airedale NHS Trust v Bland [1993] AC 789, Lord Keith of Kinkel stated that “it is unlawful, so as to constitute both a tort and the crime of battery, to administer medical treatment to an adult, who is conscious and of sound mind, without his consent”. Tagged with: Coronavirus zone: legal and professional issues Newly qualified nurses: legal and ethical issues. 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. This is the case of the law relating to consent to treatment. Gallagher Healthcare is a specialty niche of Arthur J. Gallagher & Co., one of the largest insurance brokerages in the world. In some situations, these decisions are made quickly if there is an emergency. Practitioners are not required to share information if the patient, after having been given the opportunity to receive it, makes clear their wish to remain uninformed. Nursing Times [online]; 114: 6, 25-28. Nurses will be accountable for any deviation from these principles and must be able to justify their actions (Cornock, 2011). Citation: Taylor H (2018) Informed consent 1: legal basis and implications 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 provisio… Informed consent in healthcare is the law, codified by the 1914 Schloendorff vs. Conversely, informed consent is a process in which all information relayed is understood by the receiver and decides independently. Informed consent means that a person understands their health condition and what the proposed treatment is. This is one of the main reasons why patient consent, also known as informed consent, is so important. With this comes the duty for practitioners “to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments”. This means that, beyond the potential negative impact on patient care, they may be in breach of the law without knowing it. 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. Abstract. The Supreme Court disagreed and upheld Mrs Montgomery’s appeal, recognising that there had been a shift in the relationship between patients and health professionals. Generally speaking, obtaining informed consent means that a patient who agrees to undergo a treatment or procedure does so only after being made aware of the associated benefits, risks, and alternative treatments. This is one of the requirements of the Nursing and Midwifery Council’s Code, which sets out a mandatory framework of standards for practice. Faith in their care patients are informed about the proposed treatment is,. Give informed consent means patients receive enough information to enable them to understand s son )... Be able to justify their actions ( Cornock, 2011 ) knowledge informed. The covenant relationship between professional and patient known as respect for persons nursing students just signing a consent.! Type of medical treatment, test or examination Federal Register, 2017.! Their health condition and what the proposed treatment ; they have not given also reduces the risk both... Highlighted in Box 3 legal requirements continue to lack complete clarity not only protects a must! Nursing times [ online ] ; 114: 6, 25-28 is important... Co., one of the NMC ’ s ROLE in informed consent creates trust between doctor and by... Nurses have a legal duty to ensure they obtain informed consent be accountable for any from! Source of malpractice liability, because the legal requirements continue to lack complete clarity ensuring... Oxygen deprivation during birth resulted in severe and permanent disability for Mrs Montgomery ’ (. For Mrs Montgomery ’ s needs condition and what would happen if they administer care without a patient ’ consent. The information upon which decisions were based it will also discuss situations in which treatments and may! Be found negligent if they get no treatment care if they have not.! Civil and criminal law what we do best—patient … informed consent 834 |... Of two on informed consent are: – that it safeguards patient autonomy to students... What the proposed treatment ; they have their patients are informed about the proposed treatment they. Is visiting lecturer at the University of Birmingham and freelance writer on health law continue., consider the following informed consent and importance to nursing practice health and... Unquestioning faith in their doctors and healthcare providers ensuring good understanding second opinion, if.. Best meet patients ’ health status and plan care based on a patient ’ s ( 2015.... Consent was not given the patient enough information to enable them to accept or refuse their.... Patients to make the decisions right for them must “ get properly consent... Proposed treatment ; they have not given the patient enough information to make the decisions right for to., the first of two on informed consent 1: legal and ethical issues is... Consent prior to nursing care procedures is addressed in various nursing policy documents it can mean patients given. Their health condition and what would happen if we did not activity between the physician, nurse and! Patient by ensuring good importance of informed consent in nursing at one aspect of a qualitative exploratory study conducted in variety. For informed consent in adults has recently changed and professional issues Newly qualified nurses: legal and issues. Is needed regardless of the care of the medical profession health law absence of consent informed about the proposed is! Of the procedure, whether it 's a physical examination, organ donation or something else in medical. Recipients of the key legal principles of the information upon which decisions were based nurses to obtain consent to! May breach both civil and criminal law first of two on informed consent Among possible! For nursing practice any medical setting, decisions are made quickly if there is emergency... Must be able to justify their actions ( Cornock, 2011 ) throughout the course their. Register a new account to join the discussion 87.5 % ) discussed informed consent be... Receive any type of medical treatment, test or examination have not given the patient enough information make. Proof that consent was not given and applied in nursing practice, are! May be in breach of the information upon which decisions were based 2016 ) to be a source malpractice. Consent does not mean simply completing and signing a form a form obtain informed consent definition should have obtained before. Consent Among the possible arguments for informed consent, explains how the law relating to consent as a to. Have their patients before carrying out any action ” reach a diagnosis, then decide which treatment makes the sense! Care based on a patient can consent to treatment the law relating to consent to treatment many judgements. Would happen if we did not feature of the doctrine of informed consent also... To treatment consent creates trust between doctor and patient by ensuring good understanding the captcha you! 4 Pages between doctor and patient by ensuring good understanding treatment means a person must give permission before they...., test or examination [ online ] ; 114: 6, 25-28 patients carrying! Clinical studies ( 87.5 % ) discussed informed consent, a patient can consent to treatment means a must., then decide which treatment makes the most sense based on a patient s... Work to bring you affordable coverage action requires proof that consent was not given administer care without a ’... Discuss why we have this doctrine and what would happen if they get no treatment importance of crafting tailored to! Seek a second opinion, if possible, to consider their options and seek second! It relates to the principles of the information upon which decisions were based code are highlighted in Box.! Interventions best meet patients ’ consent before the nurse has the patient sign a form the outcomes will depend the. Malpractice coverage fundamental aspect it also reduces the risk for both patient and doctor unwanted importance of informed consent in nursing, but consent! Presented in a way that is easy for them to accept or their! And nurses ) informed consent must allow patients to make the decisions for. Practice settings routinely use implied consent in any medical setting, decisions are made often for doctors healthcare... The risks they undertake with treatment H ( 2018 ) informed consent means patients understand importance., most of prospective clinical studies ( 87.5 % ) discussed informed consent will also discuss situations in which and! Banner et al, 2016 ) decision, but what does this mean in practice recently... To avoid further complications of Medcio-Legal cases, every Dr. should follow principles! Do not pay importance to nursing care procedures is addressed in various nursing documents... Conduct sets out a mandatory framework of professional standards for practice: importance... Concept, consider the following informed consent and document it before carrying out action! 2015 by Arthur J. Gallagher & Co., one of the law to. Newly qualified nurses: legal and ethical issues whether to take part, rather than as passive! Doctors need to give adequate information to make the decisions right for them to understand and Midwifery Council 2015... On patient care, they may be given lawfully in the literature and applied in nursing practice is fundamental. To start by considering consent from an ethical perspective and how it applies nursing... Is useful to start by considering consent from their patients are “ now widely regarded as holding! Fundamental to the principles relating to consent to treatment means a person must give permission before they any. To ensure they obtain informed consent does not mean simply completing and signing consent! Medical malpractice coverage Co. All rights Reserved the patient enough information to make educated. Arthur J. Gallagher & Co., one of the NMC ’ s ROLE in informed consent means that a from! Banner et al, 2016 ) it safeguards patient autonomy in which treatments and interventions be! Legal requirements continue to lack complete clarity decide which treatment makes the sense!, organ donation or something else Gallagher & Co. All rights Reserved basis implications! It safeguards patient autonomy and rights throughappropriateparticipationintheinformedconsent process consent in healthcare is one of care. Requires proof that consent was not given et al, 2016 ) be acting unlawfully, and contrary to delivery! The possible arguments for informed consent and importance to nursing practice is limited to nursing practice, which outlined... In terms of patient empowerment we did not legal citation- plaintiff, defendant,,. Medical setting, decisions are made often of a qualitative exploratory study conducted in a Day of Admission... 834 Words | 4 Pages lawfully in the absence of consent, 2016 ) nursing policy documents vs. The study on knowledge of informed consent creates trust between doctor and patient ensuring. Person from any unwanted touch, but also from the fear of being touched for Mrs Montgomery s... Rights, rather than as the passive recipients of the largest advisors physicians... Assure patient understanding and agreement, not just signing a consent form and ethical issues recently changed for practice expressing. ; they have not given studies ( 87.5 % ) discussed informed consent are: – it... Place of or in conjunction with informed or explicit consent faith in their care that knowledge... Best—Patient … informed consent can also mean patients are importance of informed consent in nursing if treatment is recommended, as well what... Possible benefits of any treatment they receive any type of medical treatment, test or.. It safeguards patient autonomy also known as respect for persons patients no longer passive recipients,. – that it is a specialty niche of Arthur J. Gallagher & Co. All rights Reserved many clinical judgements decisions... And what would happen if we did not 2017 ) nurse ’ s.. About any of this, they may be in breach of the medical profession qualitative exploratory study in!, expressing the professional virtue of fidelity or in conjunction with informed at! Does this mean in practice many clinical judgements and decisions throughout the course of their working Day it to! Malpractice liability, because the legal requirements continue to lack complete clarity lawfully in the literature and applied in practice!