Advice No6: Obtaining Valid Consent

Question 1

What are the 3 principles of obtaining valid consent?

Answer 1

1. Patient has capacity.
2. Consent is given voluntarily.
3. Patient is fully informed with time to reflect on information / ask questions.

Question 2

What advice is given about obtaining consent and carrying out gynaecological examinations?

Answer 2

Do not give information or ask to make important decision during gynaecological examination.

Question 3

What age are women presumed to have consent?

Answer 3

18
(16 in Scotland)

Question 4

What can a 16-18 year old consent to?

Answer 4

16-18 year olds can consent to treatment, but may not have the right to refuse treatment. Refusal can be overruled by parents.

Question 5

Can a 17 year old decline treatment such as diagnostic lap?

Answer 5

No - 16-18 year olds may consent to treatment, but may not refuse treatment.
Parents or courts can over rule their decision.

Question 6

For girls <16 years, who can consent to treatment?

Answer 6

1. Parents have legal right to consent.

Question 7

Under what age can a child NOT consent to sexual activity?

Answer 7

13 years.

Question 8

What is Gillick competence?

Answer 8

A child <16 years has competence if they have the maturity and understanding to make a decision.
Applies to their health and medical decisions (not just gyane).

Question 9

Summarise the Fraser Guidelines.

Answer 9

1. The child is mature and intelligent enough to understand the decision and implications.
2. Impossible to persuade the child to tell their parents or let the dr tell them.
3. The child is likely to start/continue to have sex with or without contraception.
4. Physical or mental health of the child is likely to suffer without advice or treatment.
5. Is the advice or treatment in the child’s best interest.

Question 10

What is the numerical range of a very common risk?

Answer 10

1/1 - 1/10
(person in the family).

Question 11

What is the numerical range of a common risk?

Answer 11

1/10 - 1/100
(person on the street).

Question 12

What is the numerical range of an uncommon risk?

Answer 12

1/100 - 1/1,000
(Person in the village).

Question 13

What is the numerical range of a rare risk?

Answer 13

1/1,000 - 1/10,000
(person in a small town).

Question 14

What is the numerical range of a very rare risk?

Answer 14

<1/10,000
(person in a large town).

Question 15

What is the risk of placing women directly on the waiting list?

Answer 15

Women are not being given the ‘cooling off time’ between consent and procedure.
Ensure women have time to think about the procedure and ask questions.

Question 16

What type of consent is required for gamete storage?

Answer 16

Written consent. Verbal consent is not enough!

Question 17

If a patient declines a chaperone, what measures can be taken?

Answer 17

1. A chaperone can be within earshot.
2. Gain consent in presence of chaperoned.
3. Document that patient declined chaperone.

Question 18

If unexpected disease (e.g. endo) is found mid procedure, can this be treated?

Answer 18

If the disease relates to the woman’s complaint then it can be treated IF this has been discussed with the patient pre-op.

Question 19

If a complication occurs, can additional surgery be carried out to fix this?

Answer 19

Yes - and patient should be debriefed afterwards.

Question 20

If a non-gynaecological mass is found intra-op, what should be done?

Answer 20

Nothing intra-op.
Post-op, discuss with patient and refer to relevant team.

Question 21

What should you do if pregnancy is discovered intra-op for hysterectomy for cancer?

Answer 21

This should have been ruled out pre-op.
But if found, even in cancer situations, the pregnancy should not be terminated. Stop the procedure and discuss with the patient.

Question 22

When should consent be gained in labour?

Answer 22

1. Between contractions.
2. Ideally when pain free.

Question 23

When should sterilisation be discussed with women?

Answer 23

In clinic (GOPD or ANC).
Before labour.

Do not discuss this in labour without a full discussion documented in ANC.

Question 24

When can verbal consent be used in obstetrics?

Answer 24

For simple procedures.
Emergency situations.
(but this should be witnessed by another HCP and documented).

Question 25

What 3 principles of the Mental Capacity Act?

Answer 25

1. Adults presumed to have capacity.
2. If no capacity, an independent mental capacity advocate is appointed.
3. Advance directives must be respected.

Question 26

Can a next of kin consent for a patient who lacks capacity?

Answer 26

NO!!

Question 27

What tissue is kept with patient notes?

Answer 27

Tissue samples will be destroyed, but blocks and slides will remain with the notes.

Question 28

Is consent required for photos?

Answer 28

Not required for photos to be kept with medical notes.
But consent is required if photos will be used for teaching or publication.

Question 29

Montgomery Ruling

Answer 29

Have to counsel about all risks that the patient attaches significance to.
Reasonable patient.
….

Discuss all risks that a reasonable patient in that position would consider significant in their position.