Informed consent: so much more than ‘sign there’

All too often, I hear colleagues (vets and nurses) asking a client to sign a consent form by saying “sign there”, without further discussion. A variant of this is the admitting nurse assuming the vet who advised the procedure has discussed consent with the owner.

For consent to be valid it must be “informed” consent.

Informed means if there is a significant risk in the procedure, the client needs to be told about it before he or she signs. You can never assume clients know, for example, general anaesthesia carries a risk of death.

A “significant risk” is either one with a strong chance of happening, or where a risk would be significant in some other way, such as death or paralysis. You don’t need to discuss every possible risk, but those you would judge to be worth mentioning, such as death under general anaesthesia, infection, etc.

There is invariably a small risk of something going wrong, and a client needs to be aware of this, even in very general terms – remember, even IV catheters can become infected or trigger dangerous thromboemboli. Whether this is a “significant” risk is open to debate, but it is so rare it wouldn’t need to be mentioned specifically unless risks were increased for some reason.

I also make a point of mentioning to clients they are just recording consent – they are not waiving any rights, nor are they absolving anyone of negligence or error.

It is also worth having a step in the form where the estimated cost of the procedure is specified, so what was agreed is in writing.

It is time consuming, yes, but a necessary step to take to ensure everyone is aware of the risks and what they are signing consent for.