Date with the gynaecologist: Do I need to sign this form before he proceeds?

Dear Doctor,

I am undergoing some gynaecological tests and doctors keep asking me to sign consent forms. I thought gynaecologists know best, should they not just treat me anyway?

Edna

Dear Edna,

The process of giving consent is ingrained within modern medical care. It may at first appear as an unnecessary chore, and may look like just another piece of paper to sign in the unending trail of healthcare paperwork. Consenting to medical interventions is one way of ensuring your autonomy, and maintaining the rights to make decisions about your own health.

For you to give a valid consent for any gynaecological interventions, you must first understand what the proposed intervention entails. Your gynaecologist must give you adequate information, and you must get a chance to ask questions and clarify any unclear matters. You should be very clear about the risks and benefits of what is being proposed. Other alternatives must also be discussed, including the alternative of doing nothing. Once satisfied, you should then give your consent, usually by appending your signature to a pre-prepared document.

Situations that warrant signed consent include invasive tests, treatments with significant risks, and surgical procedures. Routine interactions with your gynaecologist do not require written consents. Implied consent is usually assumed in such cases, even though you often get asked to give verbal consent for certain physical exams.

You are never under any obligation to consent to any medical interventions. You reserve the right to refuse any treatment, even when this may be in your best interests. Your gynaecologist cannot coerce you to accept and consent to any proposals either. Neither should you ever be subjected to any medical interventions without your explicit consent. If that ever happened, this would equate to battery or assault, with consequent legal implications for your healthcare team.

But under certain clinical circumstances, exceptions to the consent process exist. In emergency situations requiring immediate medical intervention to prevent serious harm or death, consenting does not apply. The law presumes that the average reasonable person would consent to treatment in most emergencies to prevent permanent disability or death. You may also be deemed incompetent to consent for yourself in certain circumstances. In such cases, family members or court appointed guardians may step in to consent on your behalf.

Don’t ever take the consenting process lightly. It provides you with an opportunity to review your treatment options. Issues that may not have been apparent previously do often come up during the time of consenting. If this happens, it becomes an opportunity to address such new concerns prior to accepting or refusing to consent. You are also entitled to keep a copy of the consent document, and should always ask for this if you wish.

— Dr Alfred Murage is a consultant gynaecologist and fertility specialist.

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