Request for Treatment: The Evolution of Consent
Annals of the Royal College of Surgeons of England 2010 March; 92(2): 93-100
INTRODUCTION: Request for Treatment (RFT) is a new approach to consent which aims to facilitate patients' understanding of their treatment and addresses some of the flaws highlighted in a literature review of current consent practice. It aims to provide a complete clinical, medicolegal, and documentary framework for consent and places patients at the centre of their care. It also provides doctors with more robust evidence that adequate consent has been obtained, and can be implemented with ease in most clinical scenarios, especially elective surgery. MATERIALS AND METHODS: A thorough critical analysis and literature review is undertaken looking at the current state of consent world-wide. For the first time, a complete documentary system for 'request for treatment' is devised including Request for Treatment forms (RFTFs) alternatively termed Patient-centred Consent Forms (PCCFs). The arguments for the legal validity and other advantages of RFT are presented. CASE STUDY: A case with all the documentation of a full consent episode is provided which illustrates RFT in action, demonstrating the simplicity of implementation, and the robustness of the completed RFT form as a source of evidence for both consent and capacity. CONCLUSIONS: Request for Treatment (RFT) is a request-based model for consent that facilitates patient-centred care. It has a number of advantages including unrivalled documentary evidence of consent in the patient's own handwriting and vocabulary, demonstration of capacity, ease of implementation, and a sound legal basis. For those who may wish to use it, RFT provides a useful and novel patient-centred method of consent, and is likely to protect against negligent consent practice by highlighting patient misunderstandings early and by providing irrefutable documentary evidence that consent has been gained. It may also provide a simple method by which Gillick competence can be assessed and documented. RFT forms are available for download at www.rft.org.uk.
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