2016 May - Informed consent
A common cause for complaints that appear before the Board involves misunderstandings between clients and veterinarians over costs and treatments; both treatments given and those offered. At the heart of these complaints lie the issues of communication and informed consent and we would all like to see these types of complaints reduced as they cause unnecessary grief for both veterinarians and clients.
The Veterinary Practitioners Code of Professional Conduct (Code) (cl 7) states:
A veterinary practitioner must, where it is practicable to do so, obtain the informed consent of the person responsible for the care of an animal before providing veterinary services to the animal.
For a veterinarian, informed consent means that information relevant to the treatment of an animal is made available to allow the client to make the best decision for their animal within their individual limitations.
It is important to note that the legislation requires informed consent to be obtained from the person responsible for the care of the animal and this may not be the owner of the animal.
Informed consent is also addressed in the Code (cl 16) which states:
A veterinary practitioner must, where it is practicable to do so and before providing veterinary services in relation to an animal, inform the person responsible for the care of the animal of:
a The likely extent and outcome of the veterinary services, and
b The estimated costs of those services
Wherever possible this should include an explanation of the diagnosis, possibilities for treatment, expected and unexpected outcomes (risks) and costs. Risks should include anaesthetic risks, negative outcomes such as death, treatment failure or complications.
Informed consent implies not just that the client was given this information, but also that they were given it in a way they could understand and explanations were offered to clarify areas of confusion.
Informed consent leads to better client compliance with treatments and better outcomes for patients.
The Board accepts that often costs are not fully known, complex medical or surgical conditions may be difficult to explain, or a definitive diagnosis may not yet be made. Under these circumstances it is important that continuing communication with the client occurs and that changes in treatment, outcomes or costs are fully explained when they become known.
Consent is not something that is given once at admission, but requires us to ensure that where practicable the client consents to any changes in the treatment or costs.
Verbal consent is acceptable but written consent ensures that there is a record of the communication between the parties and this can reduce the likelihood of future misunderstandings. If a complaint does arise it is an invaluable defence for the veterinarian.
When changes in treatment or costs occur conversations regarding informed consent should be recorded in the history.
So next time you are admitting a patient you might say to yourself have I:
1. Explained my tentative diagnosis?
2. Explained a diagnostic plan when needed?
3. Explained treatment options generally considered appropriate by the profession?
4. Explained likely outcomes for the treatment options, including reasonably foreseeable complications?
5. Explained the costs associated with treating the patient, and when those costs are to be paid?
6. Ensured I can contact the client to gain consent for deviations from the treatment plan, costs or to inform the owner of complications?
7. Asked the person responsible for the care of the animal if they have any questions or concerns regarding the current diagnosis, treatment and costs?