2. Valid consent and material risk

Consent is a process

A signature on a form is evidence that a discussion happened. It is not the consent. Valid consent is voluntary, given by someone with capacity, who has been given enough information to decide, and who understands that they can refuse or change their mind.

What “enough information” means

UK case law (Montgomery) expects you to tell the patient about risks that a reasonable person in their position would be likely to attach significance to, and any risks you know this patient would find significant. Do not hide behind a “usual risks” paragraph if this patient has a job, hobby or medical history that changes the stakes.

• What the treatment is, and why you recommend it
• Material risks and likely side effects
• Realistic alternatives, including doing nothing
• What happens if they wait or decline

Voluntariness

Pressure from a relative, a “deal” on a treatment plan, or rushing someone in the chair because the next patient is waiting can undermine consent. Give people time when the decision is not urgent. For elective cosmetic or high-cost work, a cooling-off period is good practice.

Scope

Consent is for a specific treatment, by a specific kind of clinician, in a specific setting. It does not authorise extra items you “might as well do while we are here” unless you discuss those too. If the plan changes mid-treatment, pause and re-consent when it is safe to do so.

Who takes consent

The person providing the treatment should usually take consent, or at least confirm it. A nurse can support the discussion and check understanding. They should not be left to “get the form signed” for a procedure they cannot explain.

Records

Note the options discussed, material risks mentioned, questions asked, and the decision. If an interpreter was used, record that. If the patient declined, record that clearly and without judgement.