Response to RCOG Clinical Governance Advice No. 6 – Obtaining Valid Consent

Introduction

MPS welcomes the opportunity to comment on the Clinical Governance Advice provided by the RCOG on obtaining valid consent.  It is vital to have clear and comprehensive guidance, which is specifically aimed at the different specialties, in this area.

General comments

The use of “valid consent”, “consent” and “informed consent” is inconsistent throughout the document.  We suggest using “consent”, as consent must be valid and it is unnecessary to further describe it as so.

The guidance touches on the consent issues regarding the use of a chaperone; however, it is unclear.  We suggest that this merits a separate section in the guidance.  It should specify that consent does not necessarily have to be obtained in the presence of a chaperone, but should, however, be confirmed in the presence of the chaperone.

We also suggest that it is more appropriate for the term “patient” to be used throughout the guidance, as opposed to “woman”.

Specific comments

Section 1 – Approaching consent

The first paragraph refers to “any possible alternative treatments”. We would suggest that, for clarity, this is replaced with “any reasonable or any accepted alternative treatments”.  The final sentence in this paragraph would be stronger if the word “any” was deleted, so the sentence reads: ”Uncertainties should be discussed.”

The second paragraph refers to guidance provided by the Department of Health/Welsh Office; however, it does not specifically refer to either Scotland or Northern Ireland.  We also question whether this section should refer to the NHS guidance on consent.

The third paragraph refers to taking consent and specifically states that it should be done by the doctor who intends to supervise or to carry out the procedure.  The GMC guidance on consent states that taking consent can be appropriately delegated and therefore this should be reflected in the guidance.

This paragraph also includes the statement: “Good practice principles should be remembered in obtaining consent.  Patients should be treated with courtesy and respect and their dignity should be maintained at all times.  Adequate privacy should be ensured for information giving.”  We suggest replacing “should” in this section with “must” to highlight the importance of this.  We also suggest the final sentence reads: ”Adequate privacy should be ensured.”

The final two sentences of the fourth paragraph lack clarity and it seems reasonable to state, simply, that patients may specify their preference for a female doctor and these preferences should be met.

Section 2 – The scope of the consent

For clarity we suggest that the first sentence reads: “With the exception of an emergency you should not exceed the scope of the authority given by the patient.”

Section 3 – Gynaecological procedures

Section 3.1 refers to the presence of a chaperone during gynaecological procedures.  The guidance given for when consent should be taken, and who should be present, is unclear.  Please see the General Comments section above.

Section 3.2, about discussing the possibility of oopherectomy with hysterectomy, could be expressed in clearer terms.  Also in this section, under the second bullet point, second sentence, where “previous informed consent” is referred to, we suggest it be referred to as “consent”.

In Section 3.3, bullet point three, it is unnecessary to refer to “hysterectomy operation”; and therefore for consistency, ”operation” should be deleted.

Should Section 3.4 refer to the fact that the Human Fertilisation and Embryology Act 1990 is currently being reviewed, and that it is likely that new legislation will be brought in this year?

Section 4 – Obstetrics

Section 4.1 refers to the need for Ethics Committee approval in specific circumstances. However, can research in this sector be undertaken without Ethics Committee approval?

Section 6 – Obtaining legal advice

We suggest that this section be further clarified, for situations in which the patient lacks capacity. It would be advisable to state that the doctor can also approach their medical protection organisation for advice in such difficult situations.

Appendix 1

The bulletpoint that reads “Trauma to bowel, bladder urethra and major blood vessels” should read “Trauma to bowel, bladder, urethra, or major blood vessels”.

Should you require further information about any aspects of this consultation, please do not hesitate to contact me