I have found the advice of the UK General Medical Council guidelines on decision making and consent to be excellent and would recommend them to heads of States when they are discussing communications about medical interventions such as covid19 vaccinations with patients. The GMC guidance worked well for me as a GP and led to me offering my 3000 varied patients access to everything in their notes (except third party data):
“UK General Medical Council guidelines on decision making and consent General Medical Council gmc-uk.org General Medical Council gmc-uk.org 13 COMES INTO EFFECT 9 NOVEMBER 2020
“Consent is a fundamental legal and ethical principle. All patients have the right to be involved in decisions about their treatment and care and to make informed decisions if they can. The exchange of information between doctor and patient is essential to good decision making. Serious harm can result if patients are not listened to, or if they are not given the information they need - and time and support to understand it - so they can make informed decisions about their care
“The dialogue leading to a decision pages 11, 12 and 13
“The information you give patients
10 You must give patients the information they want or need to make a decision. This will usually include:
a diagnosis and prognosis
b uncertainties about the diagnosis or prognosis, including options for further investigation
c options for treating or managing the condition, including the option to take no action
d the nature of each option, what would be involved, and the desired outcome
e the potential benefits, risks of harm, uncertainties about and likelihood of success for each option, including the option to take no action.
11 You must try to make sure the information you share with patients about the options is objective.
You should be aware of how your own preferences might influence the advice you give and the language you use.
When recommending an option for treatment or care to a patient you must explain your reasons for doing so, and share information about reasonable alternatives, including the option to take no action.
You must not put pressure on a patient to accept your advice.
12 You should not rely on assumptions about:
a the information a patient might want or need
b the factors a patient might consider significant
c the importance a patient might attach to different outcomes.
Exceptional circumstances in which you may decide not to share all relevant information
14 There may be circumstances in which you decide not to share all relevant information with a patient straight away. If you delay sharing information necessary for making a decision, you should let the patient know there’s more to discuss and make sure arrangements are made to share the information as soon as it’s appropriate to do so. You must make a record of the information you still need to share, your reasons for not sharing it now, and when it can be shared.
15 You should not withhold information a patient needs to make a decision for any other reason, including if someone close to the patient asks you to. In very exceptional circumstances you may feel that sharing information with a patient would cause them serious harm and, if so, it may be appropriate to withhold it. In this context ‘serious harm’ means more than that the patient might become upset, decide to refuse treatment, or choose an alternative. This is a limited exception and you should seek legal advice if you are considering withholding information from a patient.
HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data
Email address: richardpeterfitton7 AT gmail.com