Consent - An Overview

Following the Nuremberg trials there was a shift in medical ethics from a paternalistic model of healthcare to one based on autonomy and consent. Whilst in the past the clinician would dictate treatment and healthcare needs to the patient this has drastically shifted in the last few decades. Now we have a model of healthcare in which autonomy is paramount and the patient must consent to any treatment. They also have a greater say and involvement when it comes to decisions which relate to their health. In a sense the relationship between patient and clinician has shifted from that of a parent-child relationship to one which more closely resembles an equal partnership.


This idea of having an equal partnership with patients and respecting them as individual’s is reflected in Principle 2 of the General Medical Council’s (GMC) guidelines on consent which you can access at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/consent


“2. Whatever the context in which medical decisions are made, you must work in partnership with your patients to ensure good care. In so doing, you must: 


a. listen to patients and respect their views about their health 

b. discuss with patients what their diagnosis, prognosis, treatment and care involve 

c. share with patients the information they want or need in order to make decisions

d. maximise patients’ opportunities, and their ability, to make decisions for themselves

e. respect patients’ decisions.”


For consent to be valid it should satisfy the following conditions:


1. Voluntariness (in deciding)

Consent must be voluntary, in other words the patient’s decision must be their own. Furthermore, in line with respecting their autonomy the decision made by the patient must be free from manipulation, coercion and deceit. 

2. Informed 

The patient should have all the relevant information which they require to make decisions (see Montgomery vs Lanarkshire Health Board post).

This should take into account what you think the patient should know as well as what you think the patient themselves would like to know. In other words if there are any risks that you have identified as being specific to the patient these should also be disclosed. 

The GDC standards recommend in their Standards for the Dental Team (accessible online:https://www.gdc-uk.org/information-standards-guidance/standards-and-guidance/standards-for-the-dental-team) :

“Standard 3.1

You must obtain valid consent before starting treatment, explaining all the relevant options and the possible costs.

3.1.1 You must make sure you have valid consent before starting any treatment or investigation. This applies whether you are the first member of your team to see the patient or whether you are involved after other team members have already seen them. Do not assume that someone else has obtained the patient’s consent.

3.1.2 You should document the discussions you have with patients in the process of gaining consent. Although a signature on a form is important in verifying that a patient has given consent, it is the discussions that take place with the patient that determine whether the consent is valid.

3.1.3 You should find out what your patients want to know as well as what you think they need to know. Things that patients might want to know include:

• options for treatment, the risks and the potential benefits;

• why you think a particular treatment is necessary and appropriate for them;

• the consequences, risks and benefits of the treatment you propose;

• the likely prognosis;

• your recommended option;

• the cost of the proposed treatment;

• what might happen if the proposed treatment is not carried out; and

• whether the treatment is guaranteed, how long it is guaranteed for and any exclusions that apply.

3.1.4 You must check and document that patients have understood the information you have given.

3.1.5 Patients can withdraw their consent at any time, refuse treatment or ask for it to be stopped after it has started. You must acknowledge their right to do this and follow their wishes. You should explain the consequences or risks of not continuing the treatment and ensure that the patient knows that they are responsible for any future problems which arise as a result of not completing the treatment. You must record all this in the patient’s notes.

3.1.6 You must obtain written consent where treatment involves conscious sedation or general anaesthetic.”


3. Capacity 

Finally, the patient should have the capacity, or the ability, to make the decision. This is something that we will look at further in posts on the Mental Capacity Act 2005 and in relation to Gillick competency and the Fraser guidelines. 


“Standard 3.2

You must make sure that patients (or their representatives) understand the decisions they are being asked to make.

3.2.1 You must provide patients with sufficient information and give them a reasonable amount of time to consider that information in order to make a decision.

3.2.2 You must tailor the way you obtain consent to each patient’s needs. You should help them to make informed decisions about their care by giving them information in a format they can easily understand.

3.2.3 When obtaining consent, you should encourage patients who have communication difficulties to have a friend, relative or carer with them to help them ask questions or understand your answers.

3.2.4 You must always consider whether patients are able to make decisions about their care themselves, and avoid making assumptions about a patient’s ability to give consent. This is a complex area and you should refer to the appropriate legislation. You can find further information on our website or you can contact your defence organisation for further advice.

3.2.5 You must check and document that patients have understood the information you have given them.”

It is important to note that consent is dynamic and can change, furthermore, if there are changes to the treatment plan within a course of treatment these need to be discussed with the patient. It is also incredibly important to ensure that these discussions are written in clear, concise, contemporaneous manner in the patient’s notes. At any time during treatment the patient holds the right to decline further treatment.

“Standard 3.3

You must make sure that the patient’s consent remains valid at each stage of investigation or treatment

3.3.1 Giving and obtaining consent is a process, not a one off event. It should be part of on-going communication between patients and all members of the dental team involved in their care. You should keep patients informed about the progress of their care.

3.3.2 When carrying out an on-going course of treatment, you must make sure you have specific consent for what you are going to do during that appointment.

3.3.3 You must tailor the way you confirm ongoing consent to each patient’s needs and check that patients have understood the information you have given them.

3.3.4 You must document the discussions you have with patients in the process of confirming their ongoing consent.

3.3.5 If you think that you need to change a patient’s agreed treatment or the estimated cost, you must obtain your patient’s consent to the changes and document that you have done so.”


The videos below help summarise some of the themes we have touched upon in this post.

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Montgomery v Lanarkshire Health Board (2015)