7 Informed Consent

Informed Consent: Our Special Duty

As veterinarians, we are responsible for distilling and communication medical information to our clients that enables them to make a informed decision for patient care. There are variations among states in the specific standard applied, however most require the practitioner to disclose all risks that would impact decision-making for reasonable client in that position.^[1]

Client communications are an essential tool and veterinarians and staff must develop and practice the behavioral skills necessary for truly informed consent.  Fettman and Rolli note that in addition to the medical knowledge and procedural skills, the ethical aspects of clinical practice require client communication to establish informed consent.

Consent forms that obtain the client’s written signature for a proposed procedure is a separate act and is not required in many states as verbal consent is considered adequate. Written consent should serve to be a summary of the information discussed and does provide a form of evidence but does not suffice to replace the information and consent discussion. In addition to consent forms, handouts describing procedures and care recommendations are helpful in communicating information to the client.

In order for clients to make informed decisions, they must have the capacity of health literacy, which is defined as “the capacity to obtain process, and understand basic health information and services”^[3]. This capacity is influenced by factors that may include: culture, language, education, social skills, socioeconomic background, cognition, emotional state, auditory and visual acuity. ^[4] If we extrapolate from evidence in human medicine, that practitioners tend to overestimate health literacy, many clients leave without fully understanding discussions that the provider felt were very clear.

Applying our basic communication skills and frameworks for approaching client encounters provides an effective approach to closing the gap and minimizing client confusion, ensuring they are in a position to make an informed decision for care.  Continuing to ask an open-ended “What other questions do you have?” until your client replies “None.” is an ideal way to reduce confusion.

Of note, there are instances that do not require disclosure.  Emergency situations do not require informed consent prior to initiating stabilization treatment for life-threatening emergencies as consent is implied when the client presents the patient to the veterinarian.  In addition, when a client requests non-disclosure, the practitioner is encouraged to exercise caution, especially when risks are substantial.

From Flemming and Scott, no disclosure is required if the risk is extremely remote, if the risk is obvious/within common knowledge or if the risk is already known to the client. Finally, non-disclosure can be employed in situations where the disclosure might be harmful to the client, however this is a rare situation in veterinary medicine.