A question of consent

A medical student was shadowing a junior doctor on a paediatric surgical ward. His duties included helping the junior doctor to clerk new admissions for elective surgery, and he also observed when the doctor obtained consent for surgery.

A medical student was shadowing a junior doctor on a paediatric surgical ward. His duties included helping the junior doctor to clerk new admissions for elective surgery, and he also observed when the doctor obtained consent for surgery. 

There was a mixture of patients on the ward under ENT surgeons, general surgeons and plastic surgeons. Although the plastic surgical registrars normally obtained consent from their patients' parents, the junior doctor was responsible for getting consent for ENT patients. The children were generally admitted for tonsillectomies, grommets and other common procedures.

Three children were having grommets inserted that day. The junior doctor spoke to the father of one of the children and explained that his child was having grommets fitted in order to treat her persistent ear infections. He explained how long the procedure would take and that the child would be having a general anaesthetic. He checked that the child had no allergies. The father signed the consent form and the child went to theatre as planned.

Unfortunately, the child suffered a relatively common complication of surgery and had an extended stay in hospital. The child's mother complained and the complaints department asked the student for his comments on what had happened.

The mother believed that adequate consent was not taken. There had been no explanation of how the procedure would be performed, or by whom, and no explanation as to what the risks were, including known complications. The mother said that had she known of the complication risks she would not have let the procedure go ahead. This raised a serious issue of the procedure being performed without appropriate consent and the family were seeking legal advice with respect to a clinical negligence claim against the trust.

The student was asked to provide a statement. He sought advice from the MDU before doing so.

The MDU medico-legal adviser suggested the student review the trust's policy on consent and the GMC guidance. This emphasises the importance of sharing information and discussing treatment options with patients/parents of young children and discussing side effects, complications and other risks. The student was advised to note paragraphs 26 and 27 which refer to the responsibility for seeking a patient's consent. The doctor who is to undertake the procedure should ideally obtain consent but if this is not possible the task should only be delegated to someone who is suitably trained and qualified and has sufficient knowledge about the procedure so that they can communicate the risks and answer questions.

Another issue raised by the incident caused the trust to look at its policy. It was not uncommon for fathers or grandparents to accompany children to the hospital and the usual practice was to obtain consent from the accompanying adult. The investigation into this complaint led to the trust adopting a policy that consent should only be obtained from a person with legal parental responsibility for the child. This would be the child's mother, and only under certain circumstances, the child's father. The father of a child has parental responsibility if he was married to the mother when the child was born or unmarried but with his name on the birth certificate.

It was found that the person the junior doctor had obtained consent from was the child's stepfather and he did not have parental responsibility for her. Following the complaint, fathers accompanying children were asked to confirm they had parental responsibility for the child, and grandparents were no longer able to provide consent, unless they had obtained parental responsibility, for example, if they were the child's guardian.

This is a fictional case compiled from actual cases from the MDU's files.

This guidance was correct at publication 27/06/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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