Informed decision-making and valid consent/refusal: principles
Students should be able to demonstrate in practice an understanding of legal and ethical aspects of:
- informed consent, voluntariness and disclosure of diagnosis
- patient refusal of treatment
- the significance and limits of respect for patient autonomy
- recognition of the legal and ethical boundaries of the clinical discretion to withhold information.
Informed decision-making and valid consent/refusal: teaching and learning resources
Consent tool kit - fifth edition, BMA (2009)
Medical Protection Society resources
Department of Health publications
Reference guide to consent for examination or treatment (Second edition, 2009)
Shriver L. So Much for That, London and New York: Harper Collins, 2010.
Cover image Reprinted by Permission of HarperCollins Publishers Ltd. © 2010 Shriver, L.
Role of internet and healthcare information, disclosure of diagnosis. Husband searches for information regarding his wife’s prognosis on the internet. Her prognosis is hidden from her at the oncologist’s recommendation until her husband tells her the truth when she has 3 weeks to live, improving the quality of the end of her life.
Films and documentaries
Patient interview: Signing the consent form to end a pregnancy
In this clip, the patient describes how she didn't really read the consent form before she signed it because she was too preoccupied with what was going to happen next. The clip could be used to discuss the nature of consent and how it should be an ongoing process - and that a signature on a form is not sufficient.
Copyright © 2011 University of Oxford. Used under licence from DIPEx. All rights reserved.
The Death of Mr Lazarescu (Romania, 2005). Mr. Lazarescu, a 63 year old lonely man feels sick and calls the ambulance. When it arrives, the paramedic decides he should take him to the hospital but once there they decide to send him to another hospital and then yet another... As the night unfolds and they can't find a hospital for Mr. Lazarescu, his health starts to deteriorate fast. (IMDB.com)
The Doctor (1991?). Jack McKee is a doctor with it all: he's successful, he's rich, and he has no problems.... until he is diagnosed with throat cancer. Now that he has seen medicine, hospitals, and doctors from a patient's perspective, he realises that there is more to being a doctor than surgery and prescriptions. (IMDB.com)
Informed consent, voluntariness and disclosure of diagnosis
Jones, M A, Informed Consent and Other Fairy Stories (1999) 7 Med L Rev p103-134
Gold, M, Is honesty always the best policy? Ethical aspects of truth telling, Intern Med J. 2004 Sep-Oct; 34(9-10):578-80
Chester v Afshar  UKHL 41,  4 All ER 587 and case commentary (2005) 13 Med L Rev p102
Al Hamwi v Johnston  EWHC 206
And commentary: Miola, J, Autonomy Rued Ok?, 2005 Med Law Rev 2007 14: 108-114
Fovargue, S, Miola, J, One step forward, two steps back? The GMC, the common law and ‘informed’ consent, J Med Ethics 2010; 36:494-497
Patient refusal of treatment
Re B (Adult: Refusal of Medical Treatment)  EWHC 429
Interactive case studies: waiting room 2, GMC. Consent and children, including: access to children's medical records; if a young person refuses treatment; discussing risks; and assessing capacity,
A competent patient refuses treatment, UK Clinical Ethics Network
Recognition of the legal and ethical boundaries of the clinical discretion to withhold information
Johnston, C, and Holt, G, The legal and ethical implications of therapeutic privilege: is it ever justified to withhold treatment information from a competent patient? 2006 Clinical Ethics, 1(3) 46-151