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Principles of Obtaining Valid Consent

EthicalThere are four general principles to obtaining valid consent from all patients before beginning clinical treatment or investigation:

  • Provide information;
  • Freedom of choice;
  • Capacity;
  • Ongoing process.

Provide Information

Provide adequate information to the patient that is specific to the patient, is in a manner that can be understood by the patient and includes:

  • benefits;
  • significant risks;
  • implications of any relevant options (including the option of not having the intervention);
  • costs.

Give the patient time to consider the information and answer any questions they have.

Freedom of Choice

Ensure that the patient makes their decision voluntarily and knows that they can change their mind.

Under Scottish law (Age of Legal Capacity (Scotland) Act 1991 [1]), people aged 16 or over are presumed to have the capacity to make their own decisions. Having capacity means being able to understand and remember what is being proposed, to weigh up the relevant information, including its benefits, hazards and options, and to use this to reach a decision.

Ensure the patient has the capacity to make their own decisions when obtaining consent.

If the patient is unable to provide informed consent because they do not understand or cannot weigh up the information needed to make a decision consult your defence organisation for the most up-to-date advice.

For brief advice on obtaining consent for the care of children and adults who do not have capacity, see Communication.

Ongoing process
Consent to be examined, investigated or treated is usually an ongoing process and not a single event.

If you are in doubt as to whether a patient wishes to continue with the full care package being provided, check with the patient before proceeding.

Refer to Communication for further details.