Consent and cosmetic procedures – what lies beneath?
It is particularly interesting following Montgomery v Lanarkshire Health Board  UKSC 11 which has caused considerable debate including the extent to which there is now a duty on clinicians in all fields to inform patients of ALL potential risks of a procedure, however small.
The GMC has stated that “cosmetic practice is a challenging area of medicine which deals with patients who can be extremely vulnerable” and it is important that “doctors understand what is expected from them”.
The guidance in relation to consent includes:
- The treating doctor must carry out the process of obtaining patient consent themselves – this cannot be delegated to another member of staff. The doctor must provide the information that the patient needs to make an informed decision about treatment.
- The patient must be given time to reflect on the information provided before making any decision. The amount of time patients need for reflection and the amount and type of information they will need depends on several factors. These include the invasiveness, complexity, permanence and risks of the intervention.
- The doctor must ask the patient why they want the intervention and the outcome they hope for, before assessing whether the intervention is appropriate and likely to meet their needs.
- When discussing interventions and options, a doctor must consider a patient’s vulnerabilities and psychological needs. They must be sure that a request for a procedure is voluntary.
- A doctor must tell prospective patients if alternative interventions are available which could meet their needs with less risk, including those from other practitioners.
- A doctor must give patients clear, accurate information about the risks of the proposed intervention and any associated procedures, including anesthesia and sedation.
- A doctor must talk to the patient about any adverse outcomes that may result from the proposed intervention, paying particular attention to those the patient is most concerned about.
- The doctor must talk about the potential adverse physical and psychological impact of the intervention going wrong or failing to meet the patient’s expectations.
- A doctor must consider whether it is necessary to consult the patient’s GP to inform the discussion about benefits and risks. If so, they must seek the patient’s permission and, if they refuse, a doctor must record this in their notes and consider how this affects the balance of risk and benefit and whether the procedure should in fact be done.
From the above it is abundantly clear that for cosmetic surgeons the GMC have adopted the views of the court in Montgomery and indeed this is specifically referenced in their guidance.
It may be argued that there is nothing new in the guidance for many practitioners and Ahid Abood, a Consultant Plastic and Reconstructive surgeon at Addenbrooke’s Hospital, said the new regulations (as a whole) ‘are not before time’. However, these guidelines, whilst produced for the regulation of clinicians in plastic surgery only, will also be relevant to legal cases, perhaps in all fields, brought for a failure to obtain proper patient consent before carrying out treatment where it is alleged that this has caused harm.