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Decision Making and Consent Guidance

Decision making and consent guidance

Decision making and consent guidance was published on the 30th September 2020 and comes into effect on the 9th November 2020. The guidance will support doctors to practise shared decision making. It will help patients make healthcare decisions that are right for them.

Shared decision making and consent are fundamental to good medical practice. Serious harm can result if patients are not listened to, or if they are not given the information they need. Patients need time and support to understand the treatment choices so they can make informed decisions about their care.


The GMC Guidance Consent: Patients and Doctors Making Decisions Together (2008) was pretty robust and clear but so often departed from.

The case of Montgomery v Lanarkshire Health Board [2015] UKSC 11 is a Scottish delict, medical negligence and English tort law case on doctors and pharmacists that outlines the rule on the disclosure of risks to satisfy the criteria of an informed consent. It brought into focus the GMC guidance 2008 and reiterated the principles.

Gone are the days of the doctor deciding what treatment is best for a patient. Gone are the days of counselling the consent process on the morning of an operation. The consent form is no longer a tick box formality.

The Seven Principles of Decision Making and Consent Guidance

One: All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.

Two: Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.

Three: All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it.

Four: Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.

Five: Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care. A patient can only be judged to lack capacity to make a specific decision at a specific time, and only after assessment in line with legal requirements.

Six: The choice of treatment or care for patients who lack capacity must be of overall benefit to them, and decisions should be made in consultation with those who are close to them or advocating for them.

Seven: Patients whose right to consent is affected by law should be supported to be involved in the decision-making process, and to exercise choice if possible.


You can access the guidance here 

We encourage everyone to read the guidance. Whilst it talks of ‘shared decision making’ the ultimate decision lies with the patient. It is a fundamentally important principle for all concerned. After all : “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.”


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