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11. Communication and consent
Updated 20 March 2018
11.1 The client may be the owner of the animal, someone acting with the authority of the owner, or someone with statutory or other appropriate authority. Care should be taken when the owner is not the client. Practice staff should ensure they are satisfied that the person giving consent has the authority to provide consent. The provision of veterinary services creates a contractual relationship under which the veterinary surgeon and/or veterinary nurse should:
- ensure that clear written information is provided about practice arrangements, including the provision, initial cost and location of the out-of-hours emergency service, and information on the care of in-patients;
- take all reasonable care in using their professional skills to treat animal patients;
- keep their skills and knowledge up to date;
- keep within their own areas of competence, save for the requirement to provide emergency first aid;
- maintain clear, accurate and comprehensive case records and accounts;
- ensure that all staff are properly trained and supervised where appropriate;
- generally ensure that the client is made aware of any procedures to be performed by practice staff who are not veterinary surgeons, where appropriate;
- recognise that the client has freedom of choice;
- when referring a case, ensure that the client is made aware of the level of expertise of the referral veterinary surgeon; and
- treat clients fairly and without discrimination.
11.2 Informed consent, which is an essential part of any contract, can only be given by a client who has had the opportunity to consider a range of reasonable treatment options (including euthanasia), with associated fee estimates, and had the significance and main risks explained to them. For non-urgent procedures, the consent discussion should take place in advance of the day of the treatment/procedure where possible. The client’s consent to treatment should be obtained unless delay would adversely affect the animal's welfare.
The following matters should be considered during the discussion with the client to ensure informed consent:
- The nature, purpose, and benefits of any treatment or procedures;
- The likely outcomes of any treatment or procedures with a clear indication of both common and serious risks presented in a way that the client understands (e.g. explain any clinical terms);
- The veterinary surgeon should avoid making assumptions, for example, about a client’s financial constraints or a client’s understanding of the possible side effects, complications or the failure to achieve the desired outcome with agreed treatment;
- Financial estimates, and an agreement on any financial limits. This should also be documented on the consent form, or on an attached detailed estimate;
- Where appropriate an explanation that the diagnosis is tentative subject to further investigation;
- Checking with the client whether they have any questions or concerns regarding the diagnosis, treatment and costs;
- Informing the client (where appropriate) that other treatment is available that may have greater potential benefit than those available at the practice (see Chapter 1, Referrals and second opinions); and
- Ensuring, where possible, that consent can be obtained from the client for any deviations from the treatment plan (including costs), therefore where possible ensuring that the practice has the client’s emergency contact details and that these are up to date.
Responsibility for seeking client consent
11.3 Ordinarily it is expected that the veterinary surgeon undertaking a procedure or providing treatment is responsible for discussing this with the client and obtaining the client’s consent. If this is not practical, the veterinary surgeon can delegate the responsibility to someone else, provided the veterinary surgeon is satisfied that the person they delegate to:
- Is suitably trained, and
- Has sufficient knowledge of the proposed procedure or treatment, and understands the risks involved.
11.4 The most suitable person to delegate the responsibility of obtaining consent to would be another veterinary surgeon failing which a registered veterinary nurse or student veterinary nurse.
11.5 Where a veterinary surgeon chooses to delegate this task, the veterinary surgeon is responsible for ensuring that the client has been given enough time and information to make an informed decision, and has given their consent, before starting any treatment.
11.6 Consent forms should be viewed as an aid to consent, in conjunction with a discussion with the client.
11.7 If a client does not want to know about the possible risks and costs of a proposed procedure or treatment, this should be documented on the consent form/clinical records.
11.8 If additional procedures or tests are offered on the consent form (e.g pre-op bloods) the veterinary surgeon should ensure that the client has been advised as to the potential advantages and advised of the associated costs. This should be documented on the consent form.
11.9 Consent forms may be used to record agreement to carry out specific procedures. They form part of the clinical records. If any amendments are made subsequently, these should be initialled, dated and a note of subsequent conversations recorded on the clinical records.
11.10 For routine procedures, information leaflets can be useful to explain to clients what is involved with a specific procedure, anaesthesia, expected outcome, after care etc. Clients should be given an opportunity to consider this information before being asked to sign a consent form. Use of information sheets should be encouraged, but should not be used as a substitute for discussions with individual clients.
11.11 A copy of the form should be provided to the person signing the form unless the circumstances render this impractical. The RCVS Practice Standards Scheme Manual provides that for ‘General Practice’, signed consent forms are required for all procedures including diagnostics, medical treatments, surgery, euthanasia and when an animal is admitted to the care of a veterinary surgeon.
11.12 Specimen consent forms (form of consent for euthanasia and form of consent for anaesthesia and surgical procedures) are available to download in the 'Related documents' box at the bottom of this page.
11.13 Veterinary surgeons and veterinary nurses should seek to ensure that what both they and clients are saying is heard and understood on both sides. This could be done by asking questions and summarising the main points of the discussion.
11.14 Veterinary surgeons and veterinary nurses should encourage clients to take a full part in any discussion and to ask questions about their options or any other aspect of their animal’s care. Veterinary surgeons and veterinary nurses should make sure that clients have sufficient time to ask questions and to make decisions.
11.15 Veterinary surgeons and veterinary nurses should use language appropriate for the client and explain any clinical or technical terminology that may not be understood.
11.16 Where the client’s ability to understand is called into question, veterinary surgeons and veterinary nurses will need to consider whether any practical steps can be taken to assist the client’s understanding. For example, consider whether it would be useful for a family member or friend to be present during the consultation. Additional time may be needed to ensure the client has understood everything and had an opportunity to ask questions.
11.17 If the client's consent is in any way limited, or qualified, or specifically withheld, this should be recorded on the clinical records; veterinary surgeons and veterinary nurses must accept that their own preference for a certain course of action cannot override the client's specific wishes, other than on exceptional welfare grounds.
11.18 Provision should be made for uncertain or unexpected outcomes (e.g in relation to dental procedures). Clients should be asked to provide contact telephone numbers to ensure discussions can take place at short notice. Provision for the veterinary surgeon or veterinary nurse to act without the client’s consent if necessary in the interests of the animal should also be considered.
11.19 When arrangements have been made to bring an animal under the Animals (Scientific Procedures) Act 1986 for experimental investigation, the client should be made aware of the general provisions of the Act so that informed consent can be given.
11.20 When an animal is enrolled on a clinical trial, the client should be made aware of the general provisions of Good Clinical Practice and be supplied with any other relevant information, such as ethical guidelines and relevant contact details, so that informed consent can be given.
11.21 Practice staff may be the first to become aware of any misunderstanding by clients concerning a procedure or treatment. Veterinary surgeons and veterinary nurses should advise practice staff to communicate any concerns to the senior veterinary surgeon and ensure that the client is kept fully informed.
11.22 Veterinary surgeons and veterinary nurses in the veterinary team and different practices should be encouraged to work together to ensure effective communication with clients and with each other.
Discussion of fees
11.23 Discussion should take place with the client, covering a range of reasonable treatment options and prognoses, and the likely charges (including ancillary or associated charges, such as those for medicines/anaesthetics and likely post-operative care) in each case so as to ensure that the client is in a position to give informed consent. The higher the fee, the greater is the necessity for transparency in the giving of detailed information to the client.
11.24 It is wise for any estimate to be put in writing, or on the consent form, and to cover the approximate overall charge for any procedure or treatment including VAT, pre- and post-operative checks, any diagnostic tests, etc. The owner should be warned that additional charges may arise if complications occur. If a quote is given, it may be binding in law.
11.25 If, during the course of treatment, it becomes evident that an estimate or a limit set by the client is likely to be exceeded, the client should be contacted and informed so that consent to the increase may be obtained. This should be recorded in writing by the veterinary surgeon.
11.26 Veterinary surgeons should inform clients and others as appropriate, of any human health care implications arising from the condition, care, tests or treatment of animals, particularly those who may be more at risk.
Young persons and children
11.27 Persons under the age of 18 are generally considered to lack the capacity to make binding contracts. They should not be made liable for any veterinary or associated fees.
11.28 Persons under the age of 16 should not be asked to sign a consent form. Where they have provided a signature, parents or guardians should be asked to countersign.
11.29 Where the person seeking veterinary services is 16 or 17 years of age, veterinary surgeons should, depending on the extent of the treatment, the likely costs involved and the welfare implications for the animal, consider whether consent should be sought from parents or guardians before the work is undertaken.
11.30 Particular care should be taken when the treatment involves issues of health and safety, as for supplying Controlled Drugs (within the meaning of the Misuse of Drugs Act 1971) to anyone under the age of 18.
11.31 The Mental Capacity Act 2005 (applicable in England and Wales) states: ‘A person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain. It does not matter whether the impairment or disturbance is permanent or temporary. …’ The Adults with Incapacity (Scotland) Act 2000 provides that incapable persons are those aged 16 or over who lack one or more of: the capacity to act, make decisions, communicate decisions, understand decisions or retain the memory of decisions by reason of mental disorder or of inability to communicate because of physical disability. However, a person is not incapable only because of a lack of, or deficiency in, a faculty of communication if it can be made good by human or mechanical aid. There is currently no primary legislation dealing with mental incapacity in Northern Ireland.
11.32 Where it appears a client lacks the mental capacity to consent, veterinary surgeons should try to determine whether someone is legally entitled to act on that person’s behalf, such as someone who may act under an enduring power of attorney. If not, veterinary surgeons should act in the best interests of the animal and seek to obtain consent from someone close to the client, such as a family member who is willing to provide consent on behalf of the person.