Consent & Confidentiality for Adults

Question 1

Outline the ethical arguments surrounding the duty of confidentiality in Medical Practice.

Answer 1

Consent is not necessary if:

• When the patient is not competent to make a decision
• When there is a serious risk to others if not treated
• Adhere to GMC guidelines pages 62-79 in Consent guide

Consent to interview a patient

EXPLAIN CLEARLY & HONESTLY:

• Your name and role
• Interview for learning purposes only
• No obligation to consent
• May withdraw consent at any time
• Refusal to consent WILL NOT not affect care

Explains confidentiality clause i.e.
- Completely confidential
explain who will see notes/hear findings/see information

• shared within medical team
• exceptions addressed later

Question 2

Define ‘Valid Consent

Answer 2

BMA - ‘Consent from a patient signals informed agreement for the treatment or intervention to go ahead. The requirement to seek patient consent is therefore a strong expression of the moral obligation to respect patient autonomy. It is also required by law’.

Question 3

Explain what could happen if a doctor neglects to obtain consent from a patient before carrying out a medical procedure.

Answer 3

Ethically: Breach of Rights, Autonomy, Human Dignity

Legally: Could result in assault/battery/negligence

Benefits of consent:

• more control over their care
• more realistic expectations
• more cooperative
• establish a relationship of trust
• respectful and recognises the value of the human person

What happens when trust is broken?

• A betrayal of trust – from not pleasant to an immoral act
• Patient may no longer confide in doctor
• Doctor cannot make an accurate diagnosis –lack of information
• Detrimental to health of patient
• Detrimental to public confidence and therefore public health

Question 4

7 Principles of Decision Making and Consent

Answer 4

1. All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.
2. Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.
3. All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it.
4. Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.
5. Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care. A patient can only be judged to lack capacity to make a specific decision at a specific time, and only after assessment in line with legal requirements.
6. The choice of treatment or care for patients who lack capacity must be of overall benefit to them, and decisions should be made in consultation with those who are close to them or advocating for them.
7. Patients whose right to consent is affected by law should be supported to be involved in the decision-making process, and to exercise choice if possible.

Question 5

The Duty to warn patients about risk

Answer 5

• A surgeon owes a general duty to a patient to warn him or her in general terms of possible serious risks involved in the procedure.
• Patients should be told of any possible significant adverse outcomes of a proposed treatment GMC (2008) Consent, p. 34

Question 6

Definition of consent from Ministry of Ethics

Answer 6

‘Consent can bewritten, verbal or non-verbal/implied.A written consent form is not the actual consent itself, but evidence that consent has been given(most forms include sections to record the important aspects of the procedure the patient has been informed of). Implied consent is an action such as offering your arm for blood samples. It can be unreliable as a patient may argue that their actions were misunderstood and they did not actually wish to consent’.

Question 7

When can you breach confidentiality legally? GMC

Answer 7

• The patient consents
• The disclosure is of overall benefit to a patient who lacks the capacity to consent
• The disclosure is required by law
• The disclosure can be justified in the public interest

Question 8

The relationship between Consent & Capacity

Answer 8

Mental Capacity Act 2005

1. To understand relevant information -benefits and risks
2. To retain that information for a certain period
3. To use or weigh up that information to make a decision
4. To communicate that decision in any way possible