When a consultant, nurse or therapist asks you to agree to any form of examination, treatment or care, remember you have a choice.You are always free to say no, or to ask for more information before you make up your mind. The information below aims to answer your questions about what you have a right to expect at Vale Healthcare and what to do.

The information mainly concerns physical conditions.

Before any doctor, nurse or therapist examines or treats you they must seek your consent or permission.This could simply mean following their suggestions, such as your doctor asking to have a look at your throat and you showing your consent by opening your mouth. Sometimes they will ask you to sign a form, depending on the seriousness of what they’re proposing or whether it carries risks as well as benefits.

It does not matter so much how you show your consent: whether you sign or say you agree.What is important is that consent is genuine or valid. That means:

• you must be able to give your consent 
• you must be given enough information
• to enable you to make a decision
• you must be acting under your own
• free will and not, say, under the strong
• influence of another person.

English law assumes that if you’re an adult you are able to make your own decisions, unless it’s proved otherwise. As long as you can understand and weigh up the information you need to make the decision, you should be able to make it.

Suppose, for example you are unconscious and cannot communicate in general, people providing healthcare can still give you treatment that they believe is in your best interests.The only exception is if you have clearly refused a particular treatment in advance.

Although no-one (not even husbands, wives, partners or some close relatives) can give consent to treatment on behalf of another adult, friends and relatives may have useful advice to give.They may be able to tell healthcare professionals about the person’s beliefs and values – for example whether they have accepted or refused certain kinds of treatments in the past or have strong views on some health issues. It may therefore be appropriate to discuss your treatment with relatives or friends in case anything unexpected happens.

In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask more questions if you don’t understand or if you want more information. For example:

• What sort of things will the treatment involve? 
• What are the benefits they hope will result? 
• Are there any alternatives? 
• How good are the chances of getting such benefits? 
• What are the risks, if any? 
• If there are risks, are they minor or serious?
• What may happen if I don’t have treatment?

If the person asking for your consent to the treatment isn’t available to answer your questions, ask them to find out or arrange for someone else to talk to you about your concerns. If you would find it easier to ask questions with someone supporting you, take a relative or friend with you.You can also ask for someone of the same sex as yourself to be with you while you are being examined or treated.

Some people want to know as much as possible about their condition and possible treatments; others prefer to leave decisions to the experts. No-one providing healthcare will force information on you, for example, about the risks of treatments if you don’t want to know.

Perhaps you’re the kind of person who is prepared to take some risks if there is also a chance of a very good outcome.On the other hand, you might rather put up with some discomfort than have treatment which carries a small risk of making things worse – even though it ought to improve your condition. Only you can know what is most important to you.

Your consultant, nurse or therapist may certainly encourage you to accept particular treatment if they believe it will be helpful for you, but it is your decision whether or not to go ahead.

If you would like more time to think about your decision, say so. In emergencies, decisions may have to be made quickly, but at other times it is often possible to take as much time as you need.

You may be quite certain that you do not want a particular treatment in the future. In this case you may like to make a written record of your wishes (a document sometimes called a Living Will), and make sure people close to you know. Then if this situation arises at some point in the future and you are not in a position to tell your wishes to people providing healthcare, they will be bound by your earlier decision.

It is important to be very precise about any treatment you are refusing in advance; otherwise you could exclude treatments which you would want to accept.

It is also important to let people close to you know if you have changed your mind so they can pass on this information if necessary.

You may want to write down the sorts of treatment you would rather have, and the concerns you have about other kinds. These wishes would not be binding in the same way as an advance refusal. You cannot for example,insist on a particular kind of treatment if a healthcare professional does not believe it is right for you. But if the time ever comes that you can no longer make decisions or tell people about them, it would help people providing healthcare to have your wishes as a guide when deciding what is in your best interests.

You cannot request something that is against the law, such as euthanasia.

This may be as part of your treatment, for example to compare two different treatments; or it may be quite separate, for example being asked to provide extra blood samples for a research project. In any case a research project will always be approved by a Research Ethics Committee before you are asked to take part in it. It is for you to decide whether or not to take part.

You should usually be given an information sheet about the research project, and you should ask as many additional questions as you want before coming to a decision. If you choose not to take part,this ought not to effect the rest of your care.

If you agree to take part in a research project, and then change your mind, you are free to withdraw at any time.
 

Sometimes you may only be able to get particular treatments as part of a research trial.This is because they are new and cannot be made generally available until they have been properly tested.

If the person responsible for your care suggests that you might benefit from being in the trial, ask as many questions as you want:

• about the new treatment 
• about any risks
• and about the alternatives to being involved.

There is a type of research in which neither you nor your doctor will know whether you are being given the new treatment, the standard treatment or possibly any treatment at all. (You will always be told what options are being used in the research project, even though you will not know which option you will receive.)

If you are not happy about being involved in this or indeed any kind of trial, you will always be free to say so. You will always be able to have the available standard treatment.

All treatments, even established ones have risks and these have to be weighed up when making your decision.

You can tell the healthcare professionals concerned that you’re worried. But if you’re still not satisfied, you are entitled to complain.

In the first instance you should contact the Head of Clinical Services at Cardiff Bay Clinic, contact details below:

Karen Healey
Head of Clinic Services
Cardiff Bay Clinic
Celtic Gateway
Dunleavy Drive
Cardiff
CF11 0SN

Tel:  029 2083 6700
Fax: 029 2083 6700

Email: karen.healey@vale-healthcare.com