Students preparing for medical school interviews should have a good grasp of legal and ethical topics that can be applied to their answers.
Medical consent is a key legal aspect of practising medicine and dentistry that you must understanding before medicine or dentistry interviews.
This article will explain what medical consent is, what informed consent is, how it can be given, what happens if it is not sought properly, how it relates to medical capacity, and discuss a key legal case in the area of consent.
Combine your reading here of medicine interview questions and model answers with medicine interview tutoring or 1-1 mock interviews to ensure even greater success in your interviews.
Medical Consent Summary
Medical consent is the permission that a patient must give a healthcare professional for them to perform any medical intervention.
Consent must be obtained by all patients with capacity before any medical intervention.
Consent must be obtained from someone with capacity, and it must be informed and voluntary.
Obtaining consent differs for adults, children, those without capacity and those in emergencies.
You need to have an understanding of medical consent before interviews because it is one of the most important medico-legal topics in medical practice.
👉🏻 Read more: Ultimate Medicine Interview Preparation Guide
What is Medical Consent Law?
Medical Consent meaning
Medical consent refers to the permission that a patient must give a healthcare professional for them to give the patient any test/exam/treatment.
Consent must be given by the patient (if they can consent) before any type of procedure.
There are a few exceptions which are explained below in the ‘Situations where consent is not needed section’.
Consent can be withdrawn - if someone consented to a procedure yesterday, but does not want it carried out today, they are entitled to withdraw their consent.
👉🏻 Read more: Confidentiality In Healthcare
How is Consent Given?
Consent can be given by a patient either VERBALLY or IN WRITING.
An example of giving verbal consent is a nurse asking a patient if it is okay to take a blood pressure reading, and the patient replies “Yes”.
An example of written consent is the patient’s signature on a consent form for an operation.
Non-verbal consent is sometimes given. For example, a patient may pull up their sleeve in response to a nurse asking if they can measure their blood pressure. However, it still must be ensured that the patient has had the procedure adequately explained to them.
If consent is given, it should be documented in the patient’s notes.
What happens if consent is not given?
If a procedure/test/treatment is carried out without valid consent from the patient, it is a criminal offence. The healthcare professional could be charged with battery.
Therefore, it is incredibly important that full consent is gained from the patient before any medical intervention.
Elements of Valid Consent
Consent is not as simple as asking the patient if you can perform an exam on them and them responding with their permission. Valid consent must be VOLUNTARY, INFORMED and given by someone with CAPACITY.
Term | Definition | Example |
|---|---|---|
Voluntary Consent | The patient giving/holding their consent must be doing this without any pressure or influence from third parties. The decision must be entirely their own. | An elderly woman is giving consent for her doctors to carry out thoracic surgery. The doctors have made sure that she has not been pressured into this decision by her family members, her carers, or any other medical staff. |
Informed Consent | The health professional must ensure that they give the patient all information relating to the intervention. This includes what it involves, the benefits, any risks, any alternative treatments, what will happen after the intervention and what happens if the intervention is unsuccessful. | A man has consented to knee surgery. His doctor explained to him what the surgery involves, how it will help him, what the risks of the surgery are, what will happen if he doesn’t have the surgery, what other options are available, what his recovery will be like any medications he will need to take after, how long the surgery will take and how it will affect him long term. |
Capacity | The patient giving/holding the consent must have the capacity to do this. If a patient has the capacity, it means the patient can understand the information given, retain it, use it to make a decision and then communicate that decision to the healthcare professional. This is covered in more detail in our article on capacity in medicine. | A young deaf woman wishes to be prescribed a contraceptive pill. An interpreter is helping her converse with her doctor. She understands the information her doctor has given her, can retain it, has used it to make her decision, and communicates with the doctor through her interpreter to give her decision. |
👉🏻 Read more: Capacity in Medicine Interviews
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Informed Consent
Informed consent is the process of providing a patient with all the relevant information about a medical procedure or treatment so that they can make a voluntary decision about whether or not to undergo it.
Informed consent is an essential part of medical ethics, as it respects the patient's right to autonomy and bodily integrity.
In order to give informed consent, a patient must:
Be competent, meaning they have the ability to understand the information that is being given to them and to make a decision about their care.
Be informed, meaning they have been given all the relevant information about the procedure or treatment, including the risks, benefits, and alternatives.
Give their consent voluntarily, meaning they have not been coerced or pressured into making a decision.
If a patient is not competent, their consent cannot be obtained. In this case, a substitute decision-maker, such as a family member or close friend, may be able to give consent on their behalf.
There are a number of ways to ensure that patients are able to give informed consent.
One important step is to provide patients with clear and concise information about the procedure or treatment, in a language that they understand.
This information should include the following:
What the procedure or treatment involves
The risks and benefits of the procedure or treatment
The alternatives to the procedure or treatment
Situations Where Consent is Not Needed
Obtaining consent is not necessary when:
It is an emergency and the patient needs life-saving treatment
Additional emergency treatment is needed in surgery and it cannot wait until the person can consent
The patient has a severe mental health condition and lacks capacity under the Mental Health Act of 1983
The patient is severely unwell and is living in unhygienic conditions - they can be taken to a place of care without their consent
👉🏻 Read more: Common NHS Hot Topics
Medical Consent - Lacking Capacity
A healthcare professional should always assume a patient has the capacity unless there is evidence to suggest otherwise.
If a patient is found not to have capacity (see our article on capacity for more information), NO ONE can give consent on their behalf.
A patient who lacks capacity can still be treated, however. Any treatment carried out must be deemed in the best interests of that patient.
Deciding what is in the ‘best interests’ of a patient is complex. The healthcare professional making the decision must consider many factors:
Clinical outcomes
Past and present wishes of the patient
Beliefs and values of the patient
Anything brought up by people close to the patients/carers of the patient etc.
To summarise, for patients lacking capacity, consent cannot be provided by others. All decisions must be made in the best interests of that patient.
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Medical Consent Law in Children
Children under 16 years of age
Can consent to treat themselves if they are deemed Gillick competent - see our article on Gillick competence and Fraser guidelines for more information
If not deemed competent, a person with parental responsibility can provide consent on their behalf, as long as they have capacity
If a parent refuses to consent to treatment, the courts can overrule this and order treatment to be given in the best interests of the child
Treatment can proceed without consent if it is an emergency
Here are some examples of how the Gillick competence test may be applied in practice:
A 15-year-old girl wants to start taking birth control pills. Her parents are against it, but the doctor decides that she is Gillick competent and can consent to the treatment herself.
A 13-year-old boy with diabetes needs to have insulin injections every day. His parents are willing to help him, but he is able to do the injections himself and understands the risks and benefits of the treatment. He is therefore Gillick competent and can consent to the treatment himself.
A 10-year-old boy with a serious heart condition needs to have surgery. His parents are hesitant to consent to the surgery, but the doctors believe that it is necessary to save his life. The courts may overrule the parents' refusal to consent in this case if they believe that it is in the child's best interests.
Children Aged 16 or 17 Years Old
Children aged 16 or 17 years old are allowed to consent to their treatment, as long as they have capacity
However, children aged 16 or 17 years old do not have the absolute right to refuse to consent to treatment. A parent/guardian or the courts can override their refusal
👉🏻 Read more: Gillick Competence and Fraser Guidelines
Challenges of Obtaining Medical Consent
Gaining consent from some patients is more difficult than others. Some difficulties may arise when trying to obtain consent due to:
Language barriers
Some patients may speak limited or no English at all. Therefore, it is necessary to get an interpreter. Family members should not be interpreters.
Complex information
Doctors have to explain complex procedures to their patients for them to consent. This can be a difficult job for the doctor, as appropriate language needs to be used for the patient to fully understand the procedure in a way that’s accessible to them.
Patients with reduced hearing
Many patients in hospitals have reduced hearing. Therefore, doctors may either have to raise their voices or write out the information the patient needs to know. If the patient communicates through sign language, an interpreter needs to be present.
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Ethical Considerations and Ethical Principles of Medical Consent
There are often many ethical considerations of medico-legal topics. Therefore, it is important to understand how ethics intertwine with the topic of medical consent.
Autonomy in Medical Consent: the requirements of valid consent to treatment mean that patients are fully informed about treatment options before they make a decision. This promotes the autonomy of a patient, as it equips them with the right tools to make the decision that is best for them
Beneficence/non-maleficence in Medical Consent: Ensuring that a patient is given the correct information before providing consent, and ensuring they give it voluntarily and when they are competent enough to do, so means that harm is restricted and the patient is protected
Justice in Medical Consent: Assuming that every patient has capacity unless there is evidence to suggest otherwise ensures that each patient is treated fairly and that someone isn’t assumed to have capacity just because of the way they look, the condition they have etc.
👉🏻 Read more: Answering Medical Ethics Questions
Important Legal Case In Medical Consent: Montgomery
The case of Montgomery v Lanarkshire Health Board is important and fairly recent in the area of medical consent.
This case is particularly important because of the ‘informed’ aspect of consent.
Case background:
Mrs Montgomery was of small stature and diabetic, meaning that she was at a 9-10% increased risk of a condition called shoulder dystocia. This can cause serious complications for both mother and baby at birth, where the baby sometimes cannot be delivered vaginally.
Mrs Montgomery’s obstetrician did not feel that the risk of shoulder dystocia was an important risk to discuss with Mrs Montgomery, and thus deemed it in her best interests that the risk was not disclosed to her. The alternative of a caesarean section was also not offered to Mrs Montgomery.
Mrs Montgomery’s child was born with cerebral palsy due to complications with the birth resulting from shoulder dystocia.
Mrs Montgomery claimed that the obstetrician had been negligent in not discussing the risk of shoulder dystocia and not offering a caesarean section as an alternative.
This case was heard by the Supreme Court, the highest court in England.
Results of the case:
Mrs Montgomery was awarded over £5 million in damages, and the standard for informed medical consent in England was changed.
Whereas doctors previously were judged against what other responsible doctors believed was necessary to disclose in the consent process, doctors now must disclose ALL MATERIAL RISKS to their patients.
This means that they must disclose any risk that someone, in the patient’s position, would reasonably want to know about.
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Example scenario: gaining consent to examine a patient
Imagine you are a medical student in a respiratory ward. You and your ward partner wish to carry out a respiratory examination on a patient to practise your examination skills. What needs to be considered for the consent of the patient to be valid?
Remember that for consent to be valid, it needs to be voluntary, informed, and given by a patient with capacity.
Voluntary Consent: The patient must not be pressured by you or your ward partner into consenting to the examination. Nor should any nurses, doctors, or visitors to the patient pressure them into consenting.
Informed Consent: The patient needs to be aware of the relevant factors that will affect their decision. These will include:
What will happen in the examination - this should be explained by you and your ward partner by giving the patient a summary of the steps you’ll perform
Any risks of the examination - will this exam cause them any pain, for example
Any benefits to the exam - the medical students can track how their examination results have changed throughout their stay, for example
Any other relevant information - for example, the examination is not necessary, the findings will remain confidential and are only used for educational purposes, the students are not fully trained…
Capacity Consent: capacity should be assumed unless it is suggested otherwise. You may be able to ask the nurse in charge of the ward/bay which patients have capacity if you need help with this
If all of this is covered, then a patient can give fully valid consent to being examined.
Preparing for a Medicine Interview: Medical Consent
Consent is an extremely important topic for students to have an understanding of before interviews. It is a legal concept that you will practise throughout your time in medical school.
Consent will not only come up in the form of questions on the topic. In role-play stations in MMIs, you may be asked to consult with a “patient”, or dress a fake wound. These sorts of stations will require you to get consent from the “patient”.
It is optional to know every detail about consent, but having a good grounding in this legal concept will help you a lot in interviews.
👉🏻 Read more: Medicine Interview Topics
Medicine Interview Questions on Medical Consent
Why is valid consent important in medical practice?
What are the key components of valid consent?
Can you think of any difficulties that might arise while obtaining patient consent?
How does gaining consent differ between adults and children?
How would you handle a situation where a patient refuses treatment that is in their best interests?
What are the components of informed consent? What does the patient need to be aware of before they consent to a procedure?
What needs to be considered when obtaining consent from a patient whose first language is not English?
A patient is brought into A&E unconscious and needs life-saving treatment. What would the consent process be like?
How can you ensure that a patient understands their medical intervention before they consent?
What are some ethical considerations of the consent process?
👉🏻 Read more: 280 Medical School Practice Interview Questions
Medical Consent in Medicine Interviews: How To Answer Questions
The important things to consider when answering questions on medical consent:
Ensure that you have a good understanding of capacity as well as consent. The two legal concepts are heavily interlinked.
Be comfortable with the steps of gaining consent, as your knowledge of consent may be tested through a role-play scenario instead of formal questions (if your interview is MMI style).
Think about how the four pillars of medical ethics apply to medical consent, as this will showcase your knowledge of medical ethics in interviews.
👉🏻 Read more: MMI Medicine Interview Tips Guide
Interview model question and answer: medical consent
Q: A patient is brought into A&E unconscious and needs life-saving treatment. What would the consent process be like?
A: In an emergency situation where a patient is unconscious and requires life-saving treatment, the consent process is different from that in non-emergency situations.
In general, consent is required for any medical intervention, and it must be informed, voluntary, and given by a patient who has the capacity to make decisions. However, in an emergency, there is often not enough time to obtain informed consent from the patient or their family.
In these cases, the doctrine of implied consent applies. This means that healthcare professionals can assume that the patient would want life-saving treatment to be provided, even if they are unable to give their explicit consent.
Of course, healthcare professionals should always strive to obtain as much information as possible about the patient's wishes, even in an emergency. This may involve talking to the patient's family or friends or checking for any advance directives that the patient may have left.
However, if there is not enough time to do this, or if the patient's wishes are unclear, healthcare professionals can proceed with life-saving treatment without explicit consent.
Once the patient is conscious and well enough, healthcare professionals should explain to them what medical interventions were performed and why.
This is known as post-consent. It is important to do this so that the patient can understand what happened and make informed decisions about their future care.
👉🏻 Read more: Medicine Interview Questions Guide
Frequently Asked Questions
What are the 3 key requirements of consent?
Consent must be INFORMED, VOLUNTARY, and be given by someone WITH CAPACITY.
How long is a consent form valid for the NHS?
There is no timescale set for the validity of a consent form in the NHS. However, a patient can withdraw their consent at any point.
Can doctors record patients without consent?
Doctors must obtain consent from their patients if they wish to record them, take any photographs etc.
What are the 3 Cs of medicine?
Confidentiality, consent and capacity. Be aware of all these terms for your interviews.
Why is medical consent important?
Medical consent is necessary to obtain before all medical interventions as it ensures the patient has a choice over their healthcare, respects their autonomy, and makes sure that patients have a full understanding of what will happen to them during a medical intervention.
Who can provide consent for medical treatment?
Adult patients with capacity, 16 or 17-year-olds with capacity, under 16-year-olds who are Gillick competent, legal guardians of under 16-year-olds who are not Gillick competent and legal guardians of 16 or 17-year-olds who are refusing treatment that is in their best interests.
Can patients withdraw their consent after providing it?
Yes, patients with capacity can withdraw their consent at any point after they have provided consent.
How is medical consent documented?
Consent is documented in the patient’s medical notes. All healthcare professionals must document that consent was obtained before any medical intervention.
What is medical consent in the UK?
Medical consent is authorisation given by a patient to a healthcare professional to carry out medical tests, examinations or treatments in the UK. Valid consent must be voluntary, informed and given by someone with mental capacity.
At what age can I consent to medical treatment in the UK?
At age 16 you can legally consent to your own medical treatment in the UK. Under 16, you may still be able to consent if you demonstrate enough maturity (Gillick competence).
What does informed consent mean for medical treatment?
Informed consent means you are given all relevant details about the medical procedure to make an informed decision. This includes the steps involved, benefits, risks, alternatives and likely outcomes.
When is parental consent not needed for medical treatment?
Parental consent is not required if you are 16 or older and have mental capacity. Also in emergency lifesaving situations consent may not be needed.
Can a 16 year old refuse medical treatment in the UK?
At 16 you can refuse consent for treatment, however refusal can be overruled by parents or courts if the treatment is necessary to save your life.
How do you give consent for medical treatment?
Consent can be given verbally or in writing. Verbal consent may be saying "yes" when asked about a procedure. Written is signed on a consent form.
What if there are language barriers to medical consent?
Professionals must arrange translation services, not rely on family. The information must be explained clearly in your preferred language.
How does consent relate to medical ethics in the UK?
Consent upholds ethical principles like patient autonomy, beneficence and non-maleficence. It ensures patient choice.
What did the Montgomery case decide about UK medical consent?
Montgomery ruled doctors must disclose all material risks a reasonable patient would want to know, not just common practice risks.
Can medical consent be withdrawn in the UK?
Yes, a capable patient can withdraw consent even after signing a form. Consent is ongoing, not a one-time authorisation.
What are the 3 components of valid medical consent?
Valid consent must be voluntary, informed and given by a patient with full mental capacity to authorise treatment.
Can doctors perform procedures without consent in the UK?
Doctors can only perform procedures without consent in emergency lifesaving situations where treatment cannot be delayed.
Can parents refuse treatment for an under 16 year old in the UK?
Parents can refuse consent for an under 16, however courts can authorise medically necessary treatment against parental wishes.
Where is medical consent documented?
Consent should always be clearly documented by healthcare staff in the patient's medical records and notes.
Conclusion
Understanding medical consent is incredibly important when preparing for medicine interviews. Questions on medical consent provide a great opportunity to showcase your knowledge of legal topics within medicine.
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Great article, complements this one well: https://www.theukcatpeople.co.uk/post/understanding-medical-capacity-assessment-ethics-interview-questions