Informed consent – not always as simple as it seems

Unfamiliar circumstances?

Obtaining informed consent is an everyday occurrence, and involves thoughtful application of communication and ethics to ensure it is performed correctly, the animal’s welfare has been prioritised, and the client’s (or owner’s) wishes have been met.

There are certain scenarios which can offer some difficulties to us, and undoubtedly you will have encountered some unfamiliar circumstances in practice over the past months.

Should you get consent from the client or the owner?

As things get back to something approaching normality in veterinary practice, the idea of a “blended” approach to veterinary treatment may become the norm. As clients return to waiting rooms, or to car parks, video or telephone consultations may still be offered to those who find it difficult to get out of the house or who are isolating. There may be more occasions where your client is not the animal’s owner, having offered to bring the patient to you as a favour to a neighbour, friend or family member.

Do you accept the “agent’s” consent to treatment?

Ensuring that you have consent to proceed with treatment can be difficult in these situations. For video/phone conversations with the owner, consent can be given verbally. However, if it’s not the owner who has arrived with the animal patient, do you accept the “agent’s” consent to treatment, or do you try to have the consent conversation with the owner? The RCVS’s view is that the person presenting the animal for treatment is the client, and therefore responsible for fees, and for giving consent (although they advise care when the client is not the owner). However, it may be a better idea to contact the owner to discuss options for treatment, and to obtain their verbal consent.

So let’s look at another scenario which can often produce some issues when obtaining consent – emergency situations.

Consent for emergencies

 In our hypothetical situation, a male cat has been rushed into the practice following an RTA. Let’s consider three different scenarios.

1. The person who brings the cat into the practice is the person who ran the cat over, therefore is not known to the owner. In this case, no consent is required as the person presenting the cat does not have the owner’s authority to make decisions or give consent. Emergency and first aid treatment must be given, then the practice will attempt to find the owner. If the cat is so badly injured that he requires immediate euthanasia, then this should be performed. The person who brought the cat in should not be considered as the client.
2. The person who brings the cat into the practice is a neighbour of the cat’s owner. The owner is housebound and cannot get to the practice. The neighbour has the owner’s permission to give consent and make decisions. It’s okay to accept this consent for the initial first aid treatment. If the cat is so severely injured that he requires immediate euthanasia, it’s worth trying to contact the owner to explain this. However, in the case of our cat, it looks like he will need further treatment that may be very expensive. Although the neighbour can give consent, in these circumstances it would be better to contact the owner by telephone to obtain verbal consent. A full range of treatment options should be given, including fees for these options.
3. The person who brings the cat into the practice is the owner. Initial first aid treatment should proceed with their consent, then the options for further treatment should be discussed in detail with the owner, ensuring that clear estimates for fees are given. This situation is the “normal” consent scenario.

If you are interested in finding out more about informed consent, and gaining a useful and practical insight into making this simpler in everyday practice (with less pitfalls), then sign up for our forthcoming course on consent, which starts on 14^th September.

You can find further information on the course here.

Blog written by:

Carol Gray

BVMS MA PhD MRCVS PGCertMedEd FHEA