Kirsty Sharp considers how recent changes to professional guidelines and case law have formed a more patient-centred approach to taking consent

Read this article to: 

• Learn about the new patient-centred approach 
• Discover key changes to consent regulations 
• Understand more about the Modified Montgomery Test

Recent case law and revisions to the SMC Ethical Code and Ethical Guidelines have had a notable impact on the process of seeking consent. More than ever before, you must take a patient-centred approach when providing information and advising of risks and treatment options. 

The aim of the revised 2016 guidelines, which came into force in January 2017, is to help practitioners handle ethical issues encountered in modern medical practice. Significant changes were made to areas such as medical records, consent and prescription of medicine. There are also a number of new sections dealing with, for example, telemedicine, aesthetic practice and end of life care. 

Consent - What's new? 

The new guidelines offer a comprehensive outline of the doctor’s role in the consent process, and act as a reminder of why it is essential that it is done well. 

It reminds doctors that consent is an important part of patient autonomy. It enables patients to make voluntary decisions about their medical care, after having known and understood the benefits and risks involved prior to any treatment or procedure taking place.

The guidance demonstrates that there is not only a legal imperative, but a professional obligation, to move to a patient-centred approach when providing information and advising of risks and treatment options. You should ensure that patients have adequate information to make informed choices about medical management.

For example, point 3 indicates: “You must ensure that patients are made aware of the purpose of tests, treatments or procedures to be performed on them, as well as the benefits, significant limitations, material risks (including those that would be important to patients in their particular circumstances) and possible complications as well as alternatives available to them.” 

To read all the guidance on consent, visit goo.gl/GA5S9d

How is the modified Montgomery test linked to consent? 

Following a landmark decision by the Court of Appeal (Singapore Court of Appeal in Hii Chii Kok v Ooi Peng Jin London Lucien [2017] SGCA 38), the Bolam test (with Bolitho addendum) no longer applied to advice provided by doctors. This has been replaced by the Modified Montgomery Test, which obliges physicians to provide sufficient information to enable patients to exercise their autonomy and make informed decisions about their care. 

While this standard applies to the provision of information generally, it goes right to the heart of consent, ensuring that a patient is sufficiently informed of the risks and reasonable treatment options, including non-treatment if that is a reasonable option. 

The Test has been framed as a three-stage test that the Courts will apply when considering whether a doctor has been negligent in his advice. Under the Test: 

1. The patient must show that the information the doctor failed to disclose was information that would be relevant and material to a reasonable patient situated in the particular patient’s position, or information that the physician knew would be important to the particular patient in question.
2. If the patient successfully shows this, the Court will determine whether the doctor was in possession of the information. 
3. Finally, if the doctor was in possession of the information, they must show that they were justified in withholding the information, otherwise there would be a breach in the standard of care. 

This approach involves understanding your patient’s individual needs and circumstances more than ever before, and building this in to your consenting process, so that the patient is appropriately informed.

More advice 

If you have any questions about how the changes affect you and your practice, please do contact us either by email at [email protected] or call our toll free number on 800 616 7055. 

You will find additional advice relating to consent in our factsheet called ‘Consent – the basics’. Visit medicalprotection.org and click on the ‘Journals & resources’ tab. 

We also have a news story which provides more detail on the Modified Montgomery Test. Visit medicalprotection.org and click on the ‘Journals & resources’ tab.

Workshops

We offer a risk management workshop on Mastering Shared Decision Making for those members who wish to explore the challenges that can be faced in the decision-making process, and what techniques can be used to reduce the associated risks. For more information, visit medicalprotection.org and click on the 'Education & events' tab.