188ÌåÓý

Consent is when you give your permission or agreement for any of the following:

• an investigation
• a treatment
• a procedure
• to receive or use a service from the hospital
• to be a patient in a research project or
• be involved in teaching for hospital staff

We will use the term ‘treatment’ here to include any of these areas where your consent may be requested.

Consent should involve a process of communication about the treatment being offered to you.

You should be given enough information to help you understand the type of treatment.

You should be given enough information on the benefits and risks involved in having the treatment.

Consent discussions may involve a number of conversations with you, rather than being something that’s decided during one conversation.

You have an ethical and legal right to control your own life. You have the right to make decisions on things that relate to you. You have a right to have information provided to you to help you make these decisions and to decide what happens to your body.

It is very important that the consent you give for any treatment is ‘valid’.

For consent to be valid, you must:

• Be making a voluntary (free) choice and not feel like you are being forced into any decision
• Have received enough information in a way that you can understand about the type of treatment
• This includes information on:
  • the benefits or good the treatment could do for you
  • important risks of things going wrong with the treatment
  • how you could be harmed if the treatment does go wrong
  • any treatments you could have instead
  • your choice not to have the treatment
• Be able to make the decision about whether or not to have the treatment and to be given the help you need to make the decision.

The healthcare professional, for example your doctor or nurse, who is giving you the treatment is the responsible person to seek your consent.

Sometimes another healthcare professional who is not the person giving the treatment may be allowed to ask for your consent, as long as that person:

• Is suitably trained and qualified
• Knows enough about the treatment to explain its benefits and risks to you
• Is able to give you the information that you need to make your decision

However, the healthcare professional who actually gives the treatment remains responsible for making sure that the consent you give is valid.

Consent does not always have to be signed for. It is valid if given in any of the following ways:

• Verbally, which means spoken
• Non-verbally which could be by a clear sign or a signal if someone cannot speak
• In writing, this can be either on paper or on an electronic device like a mobile phone or computer, either way your signature is valid
• By implication (such as where you hold out your arm for a blood pressure reading)

Consent should never be about ‘getting the form signed’. Consent conversations are extremely important and the signed consent form is just one way or recording that these conversations have occurred.

Consent involves a continuous process of keeping you up to date with any changes in your condition and the interventions proposed. The timing and possible need for revisiting or repeating a consent discussion will depend on the nature and urgency of the intervention. There are no legal provisions relating to the duration of consent for major interventions.

However, it is good practice, where possible, that you consent to the proposed intervention well in advance, so that there is sufficient time to respond to any questions that you might have and provide you with adequate information. This is particularly important for elective (planned in advance rather than urgently necessary) interventions and where you may have communication difficulties.

Healthcare professionals should then check, before the intervention starts, that you:

• Can remember the treatment information given previously
• That you still understand what has been agreed
• That you have no questions or concerns and
• That you still consent to proceed

This is particularly important if there is a time-lapse between the initial seeking and giving of consent and the actual date of an intervention. It is helpful to re-check that you understand the information previously provided and to address any further questions that you might have about it.

Consent for significant interventions such as an important surgical intervention should not be a once-off, ‘last minute’ event and should not be reduced to getting a hurried signature on a consent form.

Accordingly, it is not appropriate to seek consent from you:

• Just before an intervention is due to start, at a time when you may be feeling particularly vulnerable and unable to ask relevant questions; or
• When you are sedated (including from pre-operative medication), in severe pain or extremely anxious.

Fresh consent, following provision of appropriate information, should be sought if:

• You are not satisfied that you can remember and understand the information provided earlier; or
• Your decision-making capacity to consent is in question; or
• There is a change in your condition; or
• There has been a significant change in the nature, purpose or risks associated with the intervention since consent was originally given

There are some situations when it is best practice that you do sign a consent form. These situations include if:

• The treatment is invasive (that is it enters your body), complex or involves significant risks
• The treatment is one that is planned in advance and is not an emergency
• The treatment could have significant consequences for your employment, or social or personal life
• The treatment is new, not fully tested or experimental
• Providing clinical care is not the main purpose of what consent is being asked for, for example clinical photographs for teaching purposes (which also requires consent to data processing)
• A staff member is having blood testing following needle stick injury

You must receive enough information in a way that you can understand.

You should expect to be told about:

• What the treatment is, what it involves and when it needs to be given
• How likely it is that the treatment will go well or could go badly
• What could happen if you didn’t have the treatment or had a different treatment  
• Whether a proposed treatment has been proven to work or is still being tested or is part of a research project or clinical trial. (The person asking for your consent will explain what the research project or a clinical trial is about)
• If there is any cost to having the treatment and how it can be paid for

Yes, you can bring someone to your outpatient appointment to help discuss treatment options. This is often very helpful.

Yes, you can nearly always ask for more time to help you make your decision. However, in an emergency, you may have to decide quickly.

At other times, it is usually possible to take as much time as you need.

Yes, you may ask for help and support in making your decision. Healthcare professionals should give you all the support you need to make the decision yourself.

For people who need help making consent decisions, your healthcare professional should support you to be as involved as possible, while at the same time getting you the support you need.

Yes, consent conversations should help you feel that your healthcare professional is being open, can be trusted, and has listened to you.

Here are examples of questions that may be helpful to you:

Tests, such as blood tests or scans

• What are the tests for?
• How and when will I get the results?
• Who do I contact if I do not get the results?

Treatment

• Are there other ways to treat my condition?
• What do you recommend?
• Are there any side effects or risks? If so, what are they?
• How long will I need treatment for?
• How will I know if the treatment is working?
• How effective is this treatment or how well does it work?
• What will happen if I do not have any treatment?
• Is there anything I should stop or avoid doing?
• Is there anything I can do to help myself?

What next

• What happens next?
• Do I need to come back and see you? If so, when?
• Who do I contact if things get worse?
• Do you have any written information?
• Where can I go for more information?
• Is there a support group or any other source of help?

It is always good to come prepared to appointments with your healthcare professional. Have your list of questions ready. It is also very helpful to bring along the list of medications that you are currently taking. There are resources available to help you prepare this list (please see link to Know, Check, Ask resource below).

Yes, you can ask questions such as:

• Do you give this treatment or perform this operation often?
• How often does the treatment work when you give it?
• How often do your patients experience any problems?
• What training have you had to be able to give this treatment or do this operation?

Yes, you can ask this. In teaching hospitals, it is usual and helpful for healthcare professionals who are training to be specialists, to be to be involved in treatments. This is always done with a fully trained and experienced healthcare professional still in charge of the treatment.

Yes, you can talk to your consultant or GP about this. Doctors are used to patients looking for further information and may be able to ask another consultant to see you. Looking for a second opinion will not affect the care you can have in St James’s Hospital.

If after discussing with your healthcare team and your family or carer you are still unsure of what to do, there are a number of online resources that can support you in making your decision.

If you have what is called ‘capacity’, which means you are able to decide about a treatment, then you are allowed to withdraw your consent at any time, including when a treatment is being given.

You can show that you want the treatment to stop by saying something or giving a signal if you cannot speak. Where possible, it is useful to agree in advance with your healthcare professional how you will signal if you want the treatment to stop. For example, by raising your hand during a dental procedure or pressing the call bell during an MRI scan.

Healthcare professionals are committed to providing excellent care. If you chose not to have a treatment, they will respect your choice.

Healthcare professionals need to then discuss with you what could happen because you decided not to have the treatment and what you want to do next.

No. This is a common fear among patients which can prevent them from asking questions and seeking information. However, healthcare professionals are used to being asked a lot of questions and are expected to answer them.

Healthcare professionals are committed to providing excellent care to all their patients and you asking questions should not affect this.

• The most appropriate person to understand whether or not you have capacity to decide about a treatment is the healthcare professional with the best understanding of the specific decision that needs to be made.
• It is important to note that it is not only doctors, including psychiatrists and geriatricians, who can carry out an assessment to check a person’s capacity or ability to make certain decisions.
• For this reason, the responsibility for assessing capacity and for documenting that assessment generally rests with the healthcare professional proposing a particular intervention and seeking your consent.
• In some complex situations, the healthcare professional may wish to get expert help or a second opinion from another appropriately qualified healthcare professional.
• However, it is ultimately the healthcare professional proposing the treatment who should make sure you have the capacity to make the decision about the treatment.

• Support can be given by people to whom you have a close, ongoing personal relationship with, such as family or friends, or by anybody chosen by the you.
• The support of these people may be helpful for the healthcare professional to understand what matters to you, what your beliefs are about your treatment and what you want.
• In some circumstances, the healthcare professional should consider involving an independent advocate, a trained support person, to help you if you lack capacity.
• This makes it possible for your own choices to be heard, particularly when healthcare professionals and those close to you might disagree on treatment options.
• No other person such as a family member, “next of kin”, friend or carer and no organisation can give or refuse consent for you if you are considered to not have ability to consent unless they have specific legal authority to do so. (This has always been the case).
• Each of us can formally appoint a decision supporter under the Assisted Decision-Making (Capacity) Act 2015 with this legal authority.

There are many resources on the internet to learn about consent.  Here are some of them. 

HSE National Consent Policy, 2022

 

HSE National Consent Policy, 2022 – Easy to read version

 

HSE My Health My Voice

 

NHS Questions to Ask Your Doctor or Other Healthcare Professional

 

Cleveland Clinic Questions to Ask My Doctor

 

John Hopkins Questions to Ask My Surgeon

 

Irish Cancer Society, 2024. .

 

American College of Surgeons, 2024 Questions to Ask Before Having an Operation.

 

NICE, 2024.

 

Know check Ask – My Medicines list

 

Excellent podcast for people requiring surgery / day surgery. 

Podcast: Operation preparation. 

/operationpreparation/operationpreparationpodcast/