Informed Consent and Decision-Making

Informed consent and shared decision making are fundamental to good medical practice.

Obtaining informed consent takes place at the outset of the doctor-patient relationship, and sets the tone for future interactions.

This section explains why the exchange of information between doctor and patient is essential to good decision making. Serious harm can result if patients are not listened to, or if they are not given the information they need – and time and support to understand it – so they can make informed decisions about their care.

This section provides support for you in your conversations with your patients; and helps you to be confident you’re sharing the information they need to make decisions that are right for them.

By applying the principles in this section, you will get help to make sure that you have informed consent from your patient.

In particular, you will get help with:

What you should tell a patient when talking about risks.

What to do if your patient doesn’t want to hear information you think is relevant.

What to do if your patient may lack capacity to make a decision

What you should record.

The fundamentals of informed consent (Open Access)

Patients must be able to trust doctors with their lives and their health.  To justify such trust, practitioners are expected to show respect for human life and ensure that their practise meets the standards of conduct required by their profession.

Which information must be provided to patients?

Patients have a right to information about relevant healthcare information. This topic looks at which information must be provided, and the appropriate manner of doing so. 

What should be done where the patient has fluctuating mental capacity?

The capacity of a patient can fluctuate, and some patients may be able to make decisions at certain times but not others. This topic deals with such circumstances.

Can medication be administered without the patient’s knowledge or consent?

Practitioners sometimes raise the issue of whether it is acceptable for medication to be provided to a patient without his or her knowledge. The answer to this depends, in part, on the capacity of the patient to consent to the treatment in question.

What should the approach be where patients are mentally incapacitated and have not mandated someone to give consent on their behalf?

The HPCSA Guidelines contain specific paragraphs dealing with the question of mentally incapacitated patients where such patients are unable to give the necessary consent and have not mandated, while they were still mentally competent, another person in writing to give such consent on their behalf.

Children and the Capacity to Consent to Treatment

An important challenge for practitioners in their daily practice is to ensure that arrangements are in place for properly informed consent to be obtained, which are practical and can be implemented on a daily basis in a busy clinical environment. 

This topic looks at the different forms of consent.

How should the “best interests” of a patient be assessed?

Where a patient lacks the capacity to decide, the best interests of the person become relevant. The question arises as to what is meant by the “best interests” of the patient, and how best interests should be assessed?

When can information be disclosed for reasons other than treatment?

Confidential information can be disclosed for reasons other than the direct care of the patient. This topic looks at disclosure for reasons of education, research, monitoring and epidemiology, public health surveillance, clinical audit, administration and planning

Communicating with patients

Good communication is central to providing good healthcare. This topic explores how information should be communicated in the healthcare context.

Avoiding abuse of the practitioner’s position

Practitioners have access to considerable information about, and control over, their patient’s lives. This places great responsibility in the hands of practitioners.

Which risks must patients be warned about?

Which risks should patients be warned about? In order to make a properly informed choice about their care, patients must be aware of any important risks relating to that treatment or procedure. 

Who is responsible for obtaining informed consent?

Is there a limit to an individual's choices?