Medical Consent - Medicine Ethics Guide and Interview Questions

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

What are the 3 Cs of medicine?

The 3 Cs are consent, capacity and confidentiality. They are three of the most important medico-legal concepts you will use throughout your career, and they are closely linked: a patient needs capacity to give valid consent, and the information exchanged during that process is protected by confidentiality. Knowing all three well is a reliable way to strengthen medicine and dentistry interview answers.

1. Medical consent is the permission that a patient must give a healthcare professional for them to perform any medical intervention.
2. Consent must be obtained by all patients with capacity before any medical intervention.
3. Consent must be obtained from someone with capacity, and it must be informed and voluntary.
4. Obtaining consent differs for adults, children, those without capacity and those in emergencies.
5. 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? Meaning and UK 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Consent can be withdrawn - if someone consented to a procedure yesterday, but does not want it carried out today, they are entitled to withdraw their consent.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

Types of Consent: Verbal, Written and Implied

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.

The 3 Elements of Valid Consent: Capacity, Information & Voluntariness

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.

👉🏻 Read more: Capacity in Medicine Interviews

👉🏻 Read more: NHS Core Values

👉🏻 Read more: Medical Ethics Questions at Your Medicine Interview

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

When Is Consent Not Needed? Emergencies and Exceptions

Obtaining consent is not necessary when:

1. It is an emergency and the patient needs life-saving treatment
2. Additional emergency treatment is needed in surgery and it cannot wait until the person can consent
3. The patient has a severe mental health condition and lacks capacity under the Mental Health Act of 1983
4. 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

Consent and Patients Who Lack Capacity (Mental Capacity Act 2005)

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.

👉🏻 Read more: Martha's Rule: NHS Hot Topics

👉🏻 Read more: NHS GP Shortage and Crisis

👉🏻 Read more: Euthanasia & Assisted Dying in the UK

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.

👉🏻 Read more: BAME Staff and Racism in the NHS

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.

👉🏻 Read more: Nursing Strikes UK

👉🏻 Read more: Privatisation of the NHS

👉🏻 Read more: Whistleblowing in the NHS

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

1. What is the importance of capacity in medicine?
2. Why is valid consent important in medical practice?
3. What are the key components of valid consent?
4. Can you think of any difficulties that might arise while obtaining patient consent?
5. How does gaining consent differ between adults and children?
6. What does informed consent mean in medicine?
7. What does 'best interests' mean in medicine?
8. How would you handle a situation where a patient refuses treatment that is in their best interests?
9. What needs to be considered when obtaining consent from a patient whose first language is not English?
10. A patient is brought into A&E unconscious and needs life-saving treatment. What would the consent process be like?
11. How can you ensure that a patient understands their medical intervention before they consent?
12. What ethical components are involved in informed consent?
13. (Hard) What would you do if parents decline a life saving emergency intervention for their young child?
14. (Hard) What do you know about Jehovah's Witnesses and consent for different procedures? How would you navigate differing opinions here?

👉🏻 Read more: 280 Medical School Practice Interview Questions

👉🏻 Read more: 100+ Medical Ethics Questions For Your Medicine Interview

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

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.

Check out our Medicine Interview Tutoring and Interview Question Bank which has over 400 medicine questions and answer guides for your practice.