Policy responses and statements

Name of organisation:

General Medical Council

Name of policy document:

Review of GMC Consent Guidance

Deadline for response:

2 October 2006

Background: The GMC is in the process of developing new guidance to update and replace the existing guidance on 'Seeking Patients' Consent: the ethical considerations', 1998.

Since this guidance was published, there have been changes in the ways in which the doctor-patient relationship is viewed by the public and the profession, as well as significant changes in the law. In addition, the GMC is reaching the end of a two year review of 'Good Medical Practice', its core ethical guidance for doctors. The revised 'Good Medical Practice', to be published in the autumn, among other matters emphasises the partnership between doctor and patient. The GMC would like the new guidance to reflect this approach, and it is proposed that it will be founded on a set of core principles designed to underpin good decision-making.

The Working Group established to progress the development of this new guidance sought the views of key stakeholders, in particular on the scope, shape and direction of travel for the new guidance.

COMMENTS ON
GENERAL MEDICAL COUNCIL
REVIEW OF GMC CONSENT GUIDANCE

The Royal College of Physicians of Edinburgh is pleased to respond to the General Medical Council on its Review of GMC Consent Guidance.

QUESTIONS

Question 1 -Do you think the approach to the new guidance, as outlined in Annex A, is helpful and appropriate?

 Yes.

Comments:

New guidance is helpful and appropriate in shifting the emphasis away from a negative and legalistic approach to consent to a more positive and therapeutic emphasis on partnership between doctor and patient.  However, whether this also reflects changes in the ways in which the doctor relationship is viewed by the public depends upon what is meant by “the public”.  Whilst the implied view is certainly that of a substantial proportion of current political and media opinion, it is less clear what proportion of the population holds the same view.  We feel that the new guidance to doctors should be evidence-based and it would therefore be helpful if the GMC could demonstrate, rather than simply assert, that its new guidance is responsive to patients rather than to current political or media pressures.

Section iii of Part III is particularly important and the evidence base for this part would also be helpful.  The nuances of applying the guidance need to take all factors into account and not simply the legal distinction between adults and children with and without capacity. 

Question 2 – Do you agree with the key principles outlined in the letter?

Yes.

Comments:

Making ‘respect of autonomy’ the first principle may be mistaken, since strictly speaking autonomy is the capacity for self-determination by rules which would hold for all rational people.  In practice, however, it is often equated either with the kind of patient choice, however irrational, which the law recognises in the right to refuse treatment, or simply with the legal definition of capacity.  However, the latter does not include patients who lack legal capacity but nevertheless are entitled to be respected, while the former runs the risk of a consumerist approach at odds with medical ethics.

We feel, therefore, that perhaps ‘respect for patients as persons’ would be a more adequate overarching principle.  Since good communication is crucial to this, we feel that the fourth principle in the list should come first or second.  In respect of the third principle, we suggest ‘the appropriate partnership ….’ as a minor rephrasing.

Question 3 – Are there any other issues that you feel should be addressed in the guidance (see Annex A)?

Yes.

Comments:

Please see comments in relation to Question 2.

In addition, you might consider the following:

It may be appropriate to differentiate between decision making in the treat/not treat situation and the ‘multiple options for treatment’ scenario.  In respect of Part III, para (i) should include consideration of the role of non-medical practitioners obtaining consent.  We suggest specific mention of the place of advanced directives.  It is also important to ensure that patients who withhold consent continue to receive good medical care.

Part III, para (ii) should be expanded.  We suggest a focus on consent for potentially life-threatening procedures, consideration of the balance of imparting information versus inappropriate language and emphasis of the value of written information leaflets as part of the process.  All these would ensure voluntary decision-making.  Discussion of different presentation techniques (eg the use of IT directly to the patient or via website) would be appropriate.

Part III, para 3.  Specific mention should be made of the problems related to consent for clinical trials, particularly when patients are in a vulnerable position, in which situation perhaps the person seeking consent should not be involved in the study.  This paragraph should also include specific mention of the emergency situation when it is difficult to ascertain the patient’s wishes.

Question 4 – Is there anything in the draft outline that you think should not be included?  (See Annex A.)

No.

Comments:

Previous answers relate in part to this.

Question 5 – What do you think this guidance should be called?

Other.

Comments:

Suggestions for alternative titles include ‘Decision Making in Partnership’, ‘Patient Consent and Shared Decision Making’, ‘Sharing Decision Making with Patients’, ‘Making Decisions, respecting Patients’ or simply ‘Consent’.

Question 6 – Do you have any other comments?

The College does not have any other comments. 

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324    ext 608
Fax: 0131 220 3939

[29 September 2006]