Decision Making and Consent
General Medical Council
In force since 9 November 2020.
Summary
This GMC guidance sets out how doctors should support patients to make decisions about their care. It is built around seven principles, the heart of which is that decision-making is a dialogue: patients have the right to be involved, and doctors should find out what matters to each person so they can share information that is relevant to them. That includes the option of doing nothing, and the risks of harm and potential benefits of each option. Doctors must start from the presumption that adults have capacity, support people to make their own decisions wherever possible, and respect a capable patient's decision even if the doctor disagrees. The guidance reflects the Montgomery judgment: the question is not what a responsible body of doctors would disclose, but what this particular patient would want to know. It also covers consent for children and young people, patients who lack capacity, and situations where time is short.
Why it matters at interview
Consent is one of the most common ethics themes at interview. Knowing that it is a two-way process — not a signature on a form — is a key marker of insight.
Key takeaways
- Consent is a process of shared decision-making, not a form.
- Doctors should find out what matters to the patient and tailor information accordingly.
- Material risks are judged from the patient's perspective (reflecting Montgomery, 2015).
- Adults are presumed to have capacity; a capable patient's refusal must be respected.
- The option of taking no action should always be discussed.
How to use it
Use in refusal-of-treatment and information-sharing scenarios: 'GMC guidance and the Montgomery ruling mean I'd need to explain the risks that matter to her, not just those a doctor thinks are important.'
Questions it helps with
- A 34-year-old woman who is a Jehovah's Witness has lost a lot of blood after childbirth. She is refusing a blood transfusion, which her doctors believe is necessary to save her life. What should the doctors do?
- Parents of a one-year-old tell the practice nurse they do not want their child to have the MMR vaccine because they have read it can cause autism. How should this be handled?
- An elderly woman has been diagnosed with advanced cancer. Her son asks the doctor not to tell her, saying the news would 'destroy her'. What should the doctor do?
- Role-play: a patient has stopped taking their blood pressure tablets. Find out why and discuss it with them.
- A drug advert claims it 'halves the risk of heart attack'. What does that actually mean for a patient?