Articles

Key takeaways

• Informed consent is an ongoing discussion between you and your healthcare team.
• Your consent must be voluntary, informed, and you must have the capacity to decide.
• You have an active role in asking questions and sharing your preferences.
• You can change your mind and withdraw consent at any time.

What is informed consent in healthcare?

Informed consent means saying yes to care or treatment. It is an open and ongoing conversation between you and your healthcare professional. This conversation should give you time to ask questions, think, and discuss your options.

It is not simply a one-way process of receiving information, like a leaflet. Healthcare professionals cannot rely on a signed consent form alone. This form does not prove you fully understood the risks of a procedure.

To give consent, you must understand the treatment and what it involves. This includes its risks, consequences, and benefits.

You also need to know all other available options. You should understand what will happen if you accept treatment and if you do not.

You have the right to make decisions about your care. You can say yes, no, or not right now.

This applies to any treatment, test, or examination. Healthcare professionals must ensure you can do this.

The key elements of valid consent

Your consent must be genuine. This means it needs to have three core components: it must be voluntary, informed, and you must have the capacity to make the decision.

Voluntary consent

Consent must be given freely. No one should pressure or bully you into agreeing to treatment. This includes your family or healthcare professionals.

By law, your healthcare team must have your agreement before any medical treatment for you or your baby. They cannot treat you without your consent, or the consent of another person with parental responsibility for your baby.

As long as you can understand the decision you are making, you have the right to say no to medical treatment. This is true for any reason, even if your healthcare team is concerned that the decision could lead to harm for you or your baby.

Informed consent

You must be given the information you need before being asked for consent. This information should cover any important risks.

It should also explain any alternative treatments available. You should also know the risks of doing nothing.

If you ask specific questions, your healthcare professional must give full, honest, and factual answers. They should take the time needed to do this. Giving misleading information or not giving relevant information means consent may not be valid.

Capacity to consent

You must understand the treatment well enough to make a decision. This is called having the capacity to consent. Everyone needs to be able to communicate fully and understand what consent they are being asked for.

It is rare for someone to be unable to make their own decisions.

Exceptions include emergencies where you are unconscious. In such cases, healthcare professionals can only provide life-saving care.

Very rarely, you might not have the mental capacity to understand a choice. This can happen even when it is clearly explained.

Special care must be taken when obtaining consent from those in labour. This is especially true if they are on strong pain relief, such as powerful pain-relieving medicines (opiates).

Your role and responsibilities in the consent process

You have an active role in making decisions about your care. Care and support should focus on your individual needs, preferences, beliefs, and values.

Your healthcare team should explain risks, benefits, and possible outcomes in a way that suits your needs. They should use visual tools to help discussions.

For example, instead of saying there's a 'small risk', they should explain it clearly. An example would be: 'For every 100 people who have this procedure, one person will have this problem'. All information should be personalised to your situation.

You should have an open and ongoing conversation with time to ask questions. You can use the BRAIN framework to help you get answers:

• B – What are the Benefits?
• R – What are the Risks?
• A – What are the Alternatives?
• I – What does your Intuition say about what's right for you?
• N – What would happen if I said No or Not now?

Asking questions and getting information

Your healthcare professional must not give you misleading information. The information must be up to date and based on the latest evidence.

They must make it easy for you to ask questions and answer them properly. If they cannot answer a question, they should explain why.

If you need an interpreter, the Trust should provide one.

You can ask for things to be explained again. It is okay to ask questions about what you were told previously.

You have the right to request care. Healthcare professionals should listen to you and take you seriously when you ask for care.

For example, if you ask for pain relief, it should be given unless there are good reasons not to.

Your birth partner can help by asking questions and explaining your preferences. However, only you can give consent for your own care.

Giving and withdrawing consent during pregnancy and labour

Healthcare staff must ask for your consent every time before they touch you or do a procedure. This includes minor checks like blood tests or monitoring your blood pressure.

Even if you consented to a procedure before, they must ask for your consent again each time they perform it. Separately, if the plan of care changes, they must explain this and get your consent again.

Information should be clear.

For example, if a midwife wants to do a vaginal examination, they need to clearly state their intention. They should specify that they will be putting their fingers inside you. They must ask your permission before carrying out further interventions like a sweep.

Consent does not always need to be written down. It can be given verbally or with a gesture. You might nod your head or hold out an arm.

You can change your mind at any time. This is called withdrawing consent. You can do this even if you gave consent earlier.

If your healthcare professional suspects you no longer want treatment, they must stop as soon as possible. They should talk to you and only continue if they are sure you consent.

You can say "Stop" or "I do not consent to this treatment." You can also move away if you are able to.

For example, if you are in labour, you can ask the healthcare professional to wait. They should wait until your contraction has finished before performing a vaginal examination. You do not have to explain why you do not give consent.

No one can pressure you into making a decision. Even if a midwife or doctor disagrees, they must respect your decisions.

If you feel pressured, you can ask for a different healthcare professional.

You can decline treatment during pregnancy or labour. This is true even if your healthcare team is concerned it could lead to harm for you or your baby.