From today (9 November 2020), updated decision making and consent guidance by the General Medical Council (GMC) comes into force for all doctors.

Patient consent

The updated guidance states: “Consent is a fundamental legal and ethical principle. All patients have the right to be involved in decisions about their treatment and care and to make informed decisions if they can. The exchange of information between doctor and patient is essential to good decision making. Serious harm can result if patients are not listened to, or if they are not given the information they need – and time and support to understand it – so they can make informed decisions about their care.

“Doctors must be satisfied that they have a patient’s consent or other valid authority before providing treatment or care. The purpose of this guidance is to help doctors to meet this standard. It reflects the ethical principles that underpin good practice.”

The seven principles of decision making and consent

• 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.
• Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.
• 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.
• 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.
• 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.
• 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.
• 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.

Consequences for fitness to practise

GMC medical director and director of education and standards Professor Colin Melville warned that “…failing to share information patients need to make informed decisions about their care could worsen outcomes, lead to complaints and potentially serious harm.”

The link between patient consent and fitness to practise is clear.  Doctors failing to share information with patients who need to make informed decisions about their care could lead to complaints about a doctor’s fitness to practise and ultimately sanctions.  Relevant to any consideration by the GMC in fitness to practise proceedings would be whether its guidance had been followed in clinical practise.

Professor Melville confirmed that: “It is … critical their conversations with patients are meaningful, and that they support patients to make decisions that are right for them.”