Ethical questions are commonly asked during interviews. You may have heard of the 3Cs of ethics before – confidentiality, consent and capacity.
In this guide, we’ll be exploring the second of these Cs – Consent – including why it’s important, how it needs to be respected and how it may be brought up in your medicine interview. Let’s get started!
Written by Sharon Daniel
What is Consent?
On the most basic level, consent is defined as:
Consent – permission for something to happen or agreement to do something
Consent in medicine is when a patient gives a healthcare professional permission to carry out a medical procedure or share confidential information with specified people. It is important to note that a patient can withdraw consent at any time; for example, if they consented to a procedure 24 hours ago, they can withdraw the consent today.
The factors that need to be present for consent to be correctly taken include:
- The patient should voluntarily make the decision.
- The decision must be informed—the patient should be made aware of the risks, benefits, alternative options, and consequences of not having treatment.
- The patient must have the capacity to consent.
Capacity is an individual’s ability to make an informed decision. To be competent, the patient must understand, retain, weigh up and communicate the information they have been given. All adults(patients over 16 years old) are deemed to have capacity unless proven otherwise.
It’s worth noting that everyone is presumed to have capacity to make decisions unless it can be proved that they do not. When assessing the capacity of a patient, the doctor must determine if they have an impairment affecting the function of their mind.
If they do, the physician must consider if the impairment if sufficient enough for the patient to lack capacity. In other words, have they understood the information, can they retain it, weigh up the pros and cons and then communicate their decision? The patient must be able to do all of these.
This is directly linked with Autonomy, one of the four pillars of medical ethics, which states that “The patient has ultimate control over their medical treatment”.
Even if the doctor does not agree with the patient’s wishes, as long as the patient is informed and has the capacity, the doctor must respect the wishes of the patient even if they feel it’s unwise. For example, this idea is relevant in circumstances such as when a Jehovah’s Witness refuses a blood transfusion. Importantly, a patient’s decision does NOT have to be considered reasonable for them to be considered competent to make it.
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Informed Consent
Consent depends on the quality of information given to the patient before the procedure was conducted, and whether or not they understood what was going to happen.
It is the responsibility of the doctor to ensure the patient is informed about what they want and need to know about their treatment.
This usually entails telling the patient about the treatment options open to them, the nature of the risks associated with each treatment and what might happen if they do not accept any treatment. In order to do this to the appropriate standard, the doctor must give information in a balanced way, avoiding bias.
It is also important for the doctor to convey information in a way that the patient finds it easy to understand. For example, when communicating concepts such as risk associated to a treatment, some patients may want a risk in percentage to help them make a decision.
Consent From Childern
Parents can consent on behalf of their children who cannot consent but can’t override a child’s wishes with the capacity. A child is considered to be anyone under the age of 18 and in accordance with the Children Act (1989) anybody with parental responsibility on behalf of the child can give consent so long as the decision safeguards/promotes the welfare of the child.
For example, a parent can consent to their 6-year-old child having their appendix removed; however, they can’t refuse to let their 15-year-old child have the capacity to have their appendix removed if the child had consented to it.
The Family Reform Act 1969 allows children aged 16 or 17 to consent to treatment and have increasing levels of autonomy. However, the child will have to display Gillick Competence, named after the first case in which a competent child was acknowledged.
Mrs. Gillick challenged the legality of doctors providing contraceptive advice and treatment to children under the age of 16 without parental consent so long as the child is able to show that they are intelligent enough to understand fully what it is they are consenting to.
If a child and parent disagree, then the child’s rights to autonomy are increasingly valued the older they are and, if necessary, the courts can intervene and their decision is upheld above either the parents or the child. Certain procedures require court approval regardless of who wants it – non-therapeutic sterilisations, refusal of life-saving treatment, abortion and donation of non-regenerative tissue.
How Is Consent Obtained?
There are many methods we can use to obtain consent :
Written Consent
The patient has to sign to confirm they are happy to proceed with the procedure and understand the risks and benefits of the treatment they will be undertaking.
Verbal Consent
This needs to be extremely clear in its execution to ensure there is no misunderstanding between the patient and the doctor. It will often need to be witnessed by at least one other medic.
Implied Consent
For example, a patient may roll up the sleeves of their shirt before an injection, indicating they are happy to continue. This can be somewhat vague, so it’s important to seek out a more concrete form of consent if you’re unsure of the patient’s wishes.
In whichever way consent is obtained, the medical professional should document it in the patient’s notes.
However, there are a few situations where consent is unnecessary before continuing a procedure.
When Is Consent Not Needed In Medicine?
- Treatment is needed in an emergency life-saving situation where the patient is unable to consent. For example, a patient in a coma following an accident.
- A patient needed extra emergency treatment during surgery.
- A patient who is not treated would cause risk to the general public. For example, if a patient with tuberculosis were not treated.
- Mental Health Act 1983 – A patient with a severe mental health condition who has self-harmed, attempted to end their life or refuses treatment may be forcibly kept in hospital. For this, two doctors need to assess the patient.
In most cases, these situations are allowed in order to adhere to two of the other pillars of medical ethics; Non-Maleficence and Beneficence.
Sam Montgomery - Consent Case Study
Let’s look at an example of a case relating to consent which was not obtained properly.
In 1999, Mrs Nadine Montgomery gave birth to her son Sam in Bellshill Maternal Hospital in Lanarkshire. She had a small stature and was diabetic, meaning that she was at an increased risk of shoulder dystocia, meaning that sometimes the baby can’t be delivered vaginally.
The doctor looking after Mrs Montgomery didn’t discuss the risk with her, and as such, a Caesarean section was not offered either. Sam was born with cerebral palsy due to complications from the birth due to shoulder dystocia.
If Mrs Montgomery had been aware of the risks, she would have had a Caesarean section, and she claimed her doctor had been negligent in not discussing the risk of shoulder dystocia with her.
The case was taken to the Supreme Court in England. As a result, Mrs Montgomery was awarded over 5 million pounds in damage, and the method of obtaining informed medical consent in England also changed.
Example Medicine interview Question - Consent
We will now look at an example interview question you could be asked in an interview.
Imagine you’re a Medical student on placement in an elderly care ward. You’ve been practising abdominal examinations during your OSCE sessions and would like to practice on a patient in the ward. What factors must you consider when consenting the patient for the consent to be valid?
Example Answer:
For consent to be valid, it must be voluntary and informed, and the patient must have the capacity.
You should not pressure the patient into consenting to the examination. You should also ensure that other medical professionals or the patient’s family members do not pressure them.
You must explain to the patient what the examination will involve, the risks of the examination, such as the patient being uncomfortable during palpation, and the benefits of the exam (in this case, it’s an educational activity to improve my learning).
Before you begin explaining these things, it’s worth informing the patient that the examination is for your education and is unrelated to their health. Also, be advised that everything you do will be kept confidential between them and the healthcare team looking after them.
Lastly, we assume that everyone has capacity unless proven otherwise, but checking the patient’s notes beforehand would be a good idea. Therefore, if all of the points I mentioned are covered, it means the patient has given valid consent, and we can proceed with the examination. However, the patient may withdraw their consent at any point.
This answer lays out the three main components of valid consent. It also links to the scenario by showing specific points relating to each condition to show an interviewer that you have understood the scenario. The conclusion also indicates an understanding of the timing of confidentiality and how it can be revoked.
That concludes my guide to medical consent. Consent is one of the most important things to keep in mind during any medical activities, as the risks for misinterpreting or ignoring a patient’s wishes can have dire consequences.
However, it’s not the only principle you should be aware of, so be sure to check out our collection of medical ethics guides and case studies to be prepared for anything that could come up in your interview. Plus, with our Interview Tutoring Bundles, you’ll be able to access complete preparation support for your med school interviews, all provided by expert medicine tutors! Discover our bundles today or book a free consultation to speak with our team.
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