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Ethical Issues - Consent

Introduction

Consent to treatment lies at the heart of the relationship between the patient and the health care professional. The patient relies on the professional’s expertise, knowledge and advice, but it is up to the patient to decide whether he/she will accept or reject treatment, or in some circumstances request that the professional make the decision. The focus on patient centred care and shared decision making highlights the importance of informed consent, and this is reinforced by professional guidelines and the law. However, the issue of consent to treatment is not quite as straightforward as it may seem on initial inspection. For consent to treatment to be meaningful a person must be able to understand the information he/she is given, which must be sufficient for him/her to evaluate the available choices, and he/she must feel free to make that choice. Determining the appropriate amount of information or a person’s ability to understand and evaluate it can be difficult in a health care context, and the very nature of the health care relationship and health care setting can lead to implicit if not explicit coercion. Thus issues around consent can lead to ethical dilemmas that may be brought to a clinical ethics committee. In this section we provide a brief overview of the ethical and legal approaches that apply to consent and then look at some specific issues that may present to clinical ethics committees illustrated by hypothetical cases. The section concludes with some suggested further reading on the issues.

This section does not provide a comprehensive overview of the issues around consent and refusal, and does not make recommendations about what an ethics committee should do. It highlights issues that a committee may wish to consider and provides some ethical and legal frameworks for approaching the subject.