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29 - Ethics, consent and the law

from Section 6 - Service organization

Published online by Cambridge University Press:  05 December 2015

Andrew Heck
Affiliation:
Department of Anaesthesia, St Mary's Hospital, Manchester, UK
Ross Clark
Affiliation:
Central Manchester University Hospitals NHS
Kirsty MacLennan
Affiliation:
Manchester University Hospitals NHS Trust
Kate O'Brien
Affiliation:
Manchester University Hospitals NHS Trust
W. Ross Macnab
Affiliation:
Manchester University Hospitals NHS Trust
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Summary

Introduction

Obstetric anaesthesia poses a convergence of all the ethical and consensual dilemmas only encountered infrequently in other areas of anaesthetic practice. The patient population typically ranges from teenagers upwards, with varying degrees of capacity to consent, a varying level of understanding and information provision, but a universally high degree of expectation. Patients can present in a time-critical manner and the treatment of the mother or the baby may cause risk to one to save the other. The anaesthetist, however, is well placed to provide a unifying voice of reason in this difficult arena. Therefore it is incumbent on us to have a good grasp of all the pertinent issues. This chapter will cover the issues of consent in the obstetric population, the legal background which underpins our current situation, and finally the ethical controversy that surrounds pregnancy testing in the under-16s.

Consent

We perform consent for a number of reasons: ethical, legal and regulatory body requirements.

Ethical considerations

Ethically there are a couple of underlying principles which govern our actions in this area. The Select Committee of Medical Ethics ruled in their report in 1994 that:

Alongside the principle that human life is of special value, the principle is widely held that an individual should have some measure of autonomy to make choices about his or her life … As the law stands medical treatment may be given to competent adult patients only with their informed consent, except in an emergency.

Making your own decisions, whether this involves consenting or withholding consent, of itself promotes welfare. Seeking consent helps to establish trust between the doctor and patient, and actively involves the patient in their own care. The requirement of consent therefore promotes individual autonomy and encourages rational decision-making. These derive from the basic principle of the right to self-determination, complemented by the principle of respect for persons.

Legal considerations

The Department of Health has released the Reference Guide to Consent for Examination or Treatment (2009), which provides a guide to the legal framework that all health professionals need to take account of in obtaining valid consent for any examination, treatment or care that they propose to undertake. It stems from the case law that exists within English law and from Court of Appeal judgements, as well as the European Court of Human Rights.

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Publisher: Cambridge University Press
Print publication year: 2015

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References

General Medical Council. Consent: Patients and Doctors making Decisions Together (online). http://www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_index.asp (accessed May 2015).
Montgomery, J. (2002). Health Care Law, edn. Oxford: Oxford University Press.
Royal College of Paediatrics and Child Health (2012). Pre-procedure Pregnancy Checking in Under 16s: Guidance for Clinicians (online). Available: http://www.rcpch.ac.uk/system/files/protected/page/pregnancy%20checking%20guidance%20final.pdf (accessed May 2015).
Stauch, M., Wheat, K. and Tingle, J (2002). Sourcebook on Medical Law, edn. London: Routledge Cavendish Publishing Ltd.

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