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When must we use 'official' consent forms?

Are we obliged to obtain written consent for relatively minor procedures carried out in our surgery such as joint injections or cautery of small papillomas? There is a suggestion our PCO may be thinking along these lines.

The level of consent that is required and the manner in which that consent is recorded is a matter for your own professional judgment and is not a matter for PCO determination. The PCO may advise but not dictate!

Legally valid consent must be based on an adequate understanding of full information regarding the proposed treatment and must be given entirely voluntarily by a competent patient. Nobody may consent on behalf of a mentally incompetent adult who lacks the capacity to consent. But the natural parent with parental responsibility, or the legal guardian, may in most situations provide consent on behalf of a child.

A signature on a piece of paper does not constitute legally valid consent, but may serve as evidence of an appropriate level of consent. If the consent process is not adequate a signature on an approved form will not make that consent valid!

Completion of a consent form is generally not a legal requirement, although there are exceptions in relation to the Mental Health Act 1983 and the Human Fertilisation and Embryology Act 1990. But the use of a suitable form is good practice where a significant intervention is to take place, for example a surgical procedure under general anaesthesia. So the necessity for an 'official' consent form is a matter of individual professional judgment in each case.

For example, if the papilloma was obviously benign, cautery was obviously the treatment of choice, with minimal possibility of unpleasant complications, and if you were well-trained and skilled in the procedure, then an intelligent adult patient could be expected to understand the relevant information you should provide. Explicit verbal consent, given on a voluntary basis, would almost certainly be adequate here.

In cases where an adult patient's mental capacity is in doubt it is important to establish that the patient has understood sufficient information, does in fact have the capacity to consent and is not under any pressure to do so. Details of this assessment process and the conclusion reached should be recorded carefully in the case notes. Using an 'official' form to record the consent process may in fact be helpful to you.

In all but very simple procedures, where the consent issues are clear-cut, the 'official' forms and guidance may well be of assistance in ensuring you have taken account of, and recorded, all the relevant factors.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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