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Who should take consent?

As consent is a process centred on discussing the benefits, side effects and potential complications of proposed treatments and procedures, the person who takes consent must also be able to provide all necessary information to the patient and so, ideally, the person taking consent should be the same person providing that aspect of the patient’s care. As that is not always practicable, obtaining consent may be delegated to others providing that they are suitably trained and qualified, have sufficient knowledge of the proposed investigation or treatment, understand the risks involved and comply with the HPCSA’s guidance on consent.31

Doctors who delegate responsibility for obtaining consent remain responsible for ensuring that their patients have been given sufficient time and information to make an informed decision before embarking on treatment, and that their consent to proceed is valid.

When should consent be taken?

For many elective procedures, consent is taken in the outpatient department weeks or sometimes months prior to admission for surgery. There is no specific time limit on consent taken in advance, but further questions may occur to patients, or doubts about the wisdom of their decision may creep in during the interim.

Patients’ conditions may also change during the intervening period, or new information about the procedure may have become available. It is good practice, therefore, to confirm consent prior to the procedure, using this as an opportunity to find out if there have been any material changes since consent was first taken, and to ask the patient if there are any further questions.

The fact that consent has been confirmed should be documented, either in the patient’s medical record or as a (signed and dated) supplementary note on the original consent form.

As a general principle of good practice, if the treatment is not urgent, patients should be given plenty of time to think about their options before they consent to treatment and be encouraged to ask further questions.