Ethics, Professionalism and Health Law: Consent, Confidentiality and Negligence
What you must know
Consent must be informed, voluntary and given by a person with capacity, who can understand, retain, weigh and communicate the decision. Know how consent works in minors, in pregnancy and in emergencies. Understand confidentiality and its exceptions: patient consent, legal requirement such as notifiable disease or court order, and serious public interest. Negligence needs four elements: a duty of care, a breach of that duty measured against a reasonable practitioner, causation, and damage.
Classic traps
- A signed form is not consent. Consent is a process of explanation and understanding.
- A mature minor may consent to their own treatment where they have sufficient understanding; otherwise a parent or guardian consents. Emergency treatment may proceed without consent where delay would cause harm.
- Confidentiality may be breached when the risk to others is serious and specific, and only to the minimum extent necessary.
- Poor record keeping is one of the commonest reasons practitioners lose cases.
Rule of thumb
When unsure, ask what a reasonable colleague would do in these circumstances and what the patient actually wants to know. Document the discussion, the options, the risks and the patient's decision in the notes at the time, not later.