When consent is informed

Before physicians can treat patients, they must have valid consent. To be considered valid, the consent must be “informed.” This applies to surgical operations, all forms of medical treatment, and to diagnostic procedures involving intentional interference with the patient.

To inform patients, physicians must give them (or their substitute decision-maker, when appropriate) an adequate explanation about the nature of the proposed investigation or treatment, the anticipated outcome, significant risks, reasonably available alternatives, and potential consequences of refusal. Such information enables the patient or substitute decision-maker to reach an informed decision.

Physicians have a duty to take reasonable steps so as to be relatively satisfied that the patient does understand the information being provided — particularly where there may be language difficulties or emotional issues involved. What constitutes “reasonable steps” will very much depend on the facts and circumstances of a particular situation. The consent discussion gives the physician the opportunity to observe the patient’s reaction for signs of apparent comprehension or confusion. The ability of the patient to ask questions is required and can assist the physician in assessing the patient’s level of understanding. One way to confirm patients’ understanding is to ask them what they would say if they had to explain the investigation or treatment to a family member.

The consent discussion should be documented.

For more information on the various aspects of consent, see the CMPA handbook, Consent: A guide for Canadian physicians and the Good Practices Guide.