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Patients should have power to make own decisions about their care

20 May 2008

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Doctors have been urged to rethink their approach to discussing medical issues with their patients in new General Medical Council (GMC) guidance launched yesterday (20 May 2008).

The guidance says patients should be actively engaged in discussions, allowing them to make decisions based on their individual needs and circumstances.

As part of this approach, consent should not be seen as a “tick-box exercise”, the GMC has warned, “but as part of a wider decision-making process, in which both parties have an important role to play.”

The new guidance, Consent: patients and doctors making decisions together, sets out the key principles of good decision making – which apply to all care – from simple treatments for minor conditions to major surgery.

The new guidance reflects the recent Mental Capacity Act 2005 legislation that protects those who lack capacity to make particular decisions, but also recognises the need to maximise their ability to make decisions for themselves.

The guidance also contains advice on what to do if a patient does not want to know about their condition or the proposed treatment, or asks their doctor or someone else to make the decision for them.

Jane O’Brien, Head of Standards and Ethics at the GMC said: “The relationship between a doctor and a patient should be about partnership not paternalism. This means that doctors should work with patients to allow them to make decisions tailored to individual views, needs and circumstances, and respect the choices which they make.”

The chairman of the British Medical Association’s Medical Ethics Committee (MEC), Dr Tony Calland, said: “Attitudes in society are changing.

“Each individual patient’s circumstances are unique, and levels of risk will vary depending on each person’s history and particular situation. This means that discussions about consent should be tailored to each individual.

“Gaining valid consent is more challenging for doctors when patients lack capacity to make decisions for themselves. In recent years the legal landscape has changed to protect these patients, for example the introduction of capacity/incapacity legislation in England, Scotland and Wales.

“It is essential that doctors are aware of these changes in the law and how they affect their interactions with patients.”