Medical consent is when a patient gives permission before receiving any form of medical treatment, examination or test.
Adults are generally able to give consent, but there are times when this isn’t true. A patient may lack capacity, and therefore be deemed unable to give consent, if their ability to make decisions is impaired in some way.
In the case of young children, their guardians are able to give consent on their behalf. Consent is trickier when it comes to young adults – but you need to understand the issues, so you can treat them appropriately and safely.
Consent is an important issue to consider when dealing with medical ethics scenarios because it means that the patient has agreed to what is about to happen to them. It also enables patients and healthcare professionals to work together to make important decisions.
Consent in healthcare is defined as when all three of these criteria are met:
Medical consent is given in two main ways:
A patient could also give non-verbal consent, as long as they understand what is about to take place. For example, presenting their arm for a blood test.
Consent should be given to the medical professional who is responsible for the patient’s treatment. When a major procedure or operation is taking place, consent should be obtained well in advance. If the patient gives consent and then changes their mind before the procedure, they are entitled to withdraw their consent.
In some instances, treatment may proceed without a patient’s consent.
Examples of such instances can include:
For someone to consent for mental health treatment, they must:
If there is a lack of capacity to consent for treatment, the medical professional must make a decision in the person’s best interests and take a variety of factors into account. This could involve talking to the person’s family or close friends.
In addition to instances of lacking capacity, mental health patients may also receive treatment without consent if it’s an emergency life-saving treatment, or if they are detained/sectioned under certain sections of the Mental Health Act.
The Children Act 2004 (a reinforcement of TCA, 1989) states that adulthood is reached after the 18th birthday. This means that 18-year olds are to be treated like all other adults who are able to consent for themselves, unless there are exceptional circumstances.
16- and 17-year-olds are presumed to be able to make decisions about their health independently from their parents and are usually able to consent for themselves.
It is typically under 16s who must be assessed for competency to consent before being able to agree to an intervention. This is known as Gillick competence.
If a child is unable to demonstrate this competence, then the following people can consent on their behalf:
Consent is a difficult concept, particularly when it comes to children and young people. You should apply the four pillars of ethics to any dilemmas about consent.
When it comes to autonomy, you should think about:
This means that a child should not be able to consent to a test or treatment if they cannot understand the intervention and its accompanying risks and benefits.
For beneficence, think about:
This is particularly important when children refuse treatment. If refusing treatment may result in serious mental or physical harm, the decision may be overruled by a parent or a court of law, to ensure the best interests of the child are prioritised over autonomy.
When it comes to non-maleficence, consider:
It is important to consider whether the child is put at risk from treatment or a lack of treatment.
For justice, be sure to think about:
The Gillick test states that if a child can understand and comprehend a treatment, its implications (including the risks and benefits) and alternative options, they have the ability to consent.
To get a better understanding of applying the key pillars of ethics to consent and young children, it is worth looking into the Keira Bell case.
A 15-year-old girl comes in alone and tells her GP that she is sexually active. She also states that she would like to start taking contraception.
When it comes to capacity and consent, you should consider:
However, if the girl was engaging in sexual activity with an inappropriate adult, the situation would change. By providing treatment, you may be allowing the behaviour to continue and remain a secret from the parents, both of which would put the child at risk of harm. In this instance, Gillick competence is very important and will help the GP to understand whether sexual abuse is taking place, whether the child’s safety is at risk and whether the child is able to consent to sexual activity.
For the specific case of contraception in under 16s, it may be valuable to familiarise yourself with the Fraser guidelines.
It is possible that you will encounter questions about medical consent in your interview. Some topics that could arise are:
To find out the answer to these questions, check out our ethics questions guide.
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