Dr Savita Brito- Mutunayagam on the newly updated clinical standard on Obtaining Valid Consent in SRH services

Posted 26 Sep 2018

Date: 26 Sep 2018

Author: Dr Savita Brito-Mutunayagam

This updated standard has been launched to coincide with the FPA Sexual Health Week which explores the topic of consent. Written and published by the Clinical Standards Committee of the FSRH, this document aims to provide comprehensive standards for obtaining valid consent in SRH services.

“Familiarity can blind you too”

Robert Pirsi, from: Zen and the Art of Motorcycle Maintenance: An Inquiry Into Values

As health professionals we can get comfortable with our understanding of a subject. Especially something that feels as second nature to us as obtaining consent. Working on this standard allowed me to reflect on the principle of consent and marvel at the journey it has had through the history of medicine. From the paternalistic physician-patient relationship detailed in Hippocratic writings, to the House of Lords ruling on Gillick v West Norfolk and Wisbech AH, informed consent has undergone widespread changes influenced by law and morality.

Informed consent is an ever-evolving process which this updated standard reflects. It explores the implications of the 2015 Supreme Court ruling on Montgomery vs Lanarkshire Health Board on obtaining valid consent in clinical practice. The standard highlights that clinicians now have a “duty of care to warn of “material risks”. The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.”

In other words, a patient should be told whatever they want to know, as well as what their doctor thinks they would want to know, not just what doctors think they should know.

Of course, as clinicians we have a responsibility to keep up to date on new evidence that influences our practice. However, this process needs to be supported by leadership and management teams within SRH services. This sentiment is reflected in this document which encourages SRH services to prioritise the training and education of their staff in order to provide high quality, patient centred care.

  • All staff should have training and ongoing support in seeking and obtaining valid consent 

  • All staff should be aware of the process of obtaining valid consent. This includes: purpose, process, assessment of capacity, provision of information and assessment of a patient’s autonomy 

This document details ten standards for SRH services to adhere to, including standards on assessing capacity, recording of valid consent and dealing with those who lack capacity to make their own decisions. For my own clinical practice, I found the inclusion of tools for assessing competence most useful; such as the two-stage functional test and the U-P-S-S-I mnemonic to remember the Fraser guidelines.

I am proud of this clinical standard and hope it will be useful for many. Implementing clinical standards such as these in our services will reduce variations in practice, and ensure we meet established professional standards. Thereby, maintaining the trust of our patients.