The General Medical Council calls on doctors to rethink their approach to discussing medical problems with their patients in its guidance on obtaining consent to treatment, published this week.
The guidance, which replaces previous advice published in 1998, follows changes in legislation such as the Mental Capacity Act 2005 and the Adults with Incapacity (Scotland) Act 2000, as well as developments in case law.
The advice, which comes into effect on 2 June, tackles in detail questions such as discussing risk, advance care planning, and what to do when a patient’s mental capacity is impaired or fluctuating.
The guidance says doctors “must not assume that because a patient lacks capacity to make a decision on a particular occasion, they lack capacity to make any decisions at all, or will not be able to make similar decisions in the future.”
They should also take “all reasonable steps to plan for foreseeable changes in a patient’s capacity to make decisions” and consider the extra support needed by patients with dementia and learning disabilities.
The guidance says doctors must tell patients if a particular treatment might have a serious adverse outcome “even if the likelihood is very small.” Patients should also be warned about less serious side effects or complications if they are common.
Doctors should never withhold information necessary for making decisions for any reason—including when a relative, friend, or partner requests it—“unless you believe that giving it would cause the patient serious harm.”
A patient’s decision to refuse treatment should be respected “even if you think their decision is wrong or irrational.” Equally, doctors are not obliged to provide treatment they do not believe will benefit the patient.
Consent for any serious treatment or investigation should be in writing, says the guidance, but oral or implied consent is acceptable for more minor or routine treatments.
The booklet marked a “shift in emphasis” towards a genuine partnership between doctor and patient, said GMC president Graeme Catto. “Consent isn’t something that should be done to patients. Consent is within the gift of the patient.”
The Medical Defence Union welcomed the new guidance. Hugh Stewart, head of case decisions, said the MDU often dealt with queries over patient consent, “particularly situations where doctors may be uncertain whether a patient has capacity to consent to treatment or not.”
Neil Hunt, chief executive of the Alzheimer’s Society, which was closely involved in drawing up the new advice, said a diagnosis of dementia did not mean someone could no longer make decisions for themselves. “It is crucial to assume people with dementia have capacity, even though this may fluctuate over time.”
The guidance follows a three month consultation period last year, which included a public consultation, five workshops centred on a short play about dementia, and a series of meetings with interested organisations and individuals.
Consent: patients and doctors making decisions together is available at www.gmc-uk.org