Informed consent in paramedic practice
Abstract
Informed consent is a concept that has grown in importance over the last 40 years. It is now a key concept in modern healthcare practice and underpins all patient encounters. Any consent to assessment or treatment should be gained in an informed manner and failing to do so can lead the clinician open to accusations of negligence. Despite this many clinicians have only a vague or incorrect understanding of the concept of informed consent and what does, and does not, constitute it. The following article attempts to clarify the latest thinking in English law regarding informed consent drawing largely from the United Kingdom Supreme Court (UKSC) ruling on the subject in 2015. There then follows a discussion of a number of areas where paramedic practice in particular may be failing to meet modern standards of informed consent. It will be argued that consent in paramedic practice is often poorly sought and documented and that paramedic practice often becomes ‘defensive’ and in doing so fails to meet the required standards for informed consent.
The discussion that follows is concerned only with consent as it relates to a competent adult patient receiving treatment in England. Patients who lack capacity, are under 18 years of age, or unconscious, are special cases with regard to the granting of consent, and are not considered here.
While the majority of the literature on consent is couched in terms of doctors, it is well recognised that what applies to doctors applies equally to all other registered health professionals (Department of Health, 2009). In the following discussion therefore, the term ‘clinician’ will be employed to mean any registered health professional.
The idea of consent is a relatively new one in healthcare. It has been argued that in the past consent was not sought because the patient/clinician relationship was built on trust in the clinician's beneficence and non-maleficence (Habiba, 2000). It has further been argued that the loss of this trust based relationship has been caused by a variety of factors including the increasingly complex healthcare system leading to a breakdown in the one to one relationship patients have with their doctors and also the increasing expectations of patients (Polani, 1983 cited in Habiba, 2000).
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