While veterinarians are obliged to obtain clients' informed consent to a proposed treatment/course of action this may not be possible in an animal welfare emergency. For example, when the client/owner can't be contacted and there is an immediate threat to the life of the animal, or an immediate need to relieve unreasonable or unnecessary pain (refer to the section of this Code).
Informed consent is an interactive process between the veterinarian and client. It's not just a single approval for a treatment plan or a signed consent form. For example, further consent is required where the condition of the animal and/or treatment options change.
Client understanding is enhanced when:
information is given in lay terms (without technical jargon)
clients are given the opportunity to ask questions or request additional information
clients can relay their understanding of the information given back to the veterinarian
(where appropriate) clients are given enough time to make an informed decision.
'Enough relevant information' means sufficient, relevant information being given to a 'reasonable' person in the client's position to make a considered decision on whether to accept or reject the recommended treatment/course of action. In general:
a simple procedure involving minimal risk and using current well-recognised options will require minimal detail
a complex procedure will require detailed information, especially if less common/routine options are recommended and/or the risk is high or unknown.
The following information must be provided:
the likely diagnosis where appropriate and the reason for the proposed course of action
treatment options including expected outcomes, risks, side effects, benefits and costs (this can be a range of likely costs)
the veterinarian's experience and skills to undertake the treatment, where appropriate
referral options, where appropriate
post treatment requirements and likely costs.
A client's experience and knowledge can influence the degree of detail they need to make an informed choice. Veterinarians should not pre-judge clients' ability to take in the information conveyed/treatment recommendations and should use appropriate questions to check understanding.
The process of obtaining informed consent is ideally documented by a signed, consent form attached to the clinical record. Sample forms are available from the Veterinary Professional Insurance Society (VPIS) through NZVA. When verbal consent is given this must be noted in the clinical record.
The clinical record should also include:
a summary of relevant discussions that took place to arrive at the treatment decision/s
a client's decision not to proceed with the veterinarian's recommendation (for example declining a second opinion or referral).
The veterinarian responsible for the case must ensure that informed consent has been given before proceeding. Delegating some or all of the process to other staff (such as a veterinary nurse or receptionist) may be appropriate when:
the proposed treatment is a common procedure, especially when requested by the client eg de-sexing operations
the staff have been appropriately trained and protocols are in place and followed.
The accountability for the process remains with the veterinarian in charge of the case and there must be the opportunity for clients to talk with the veterinarian if they have expressed any concerns or request it.
Veterinarians should consider how to best communicate information to the client. It can be helpful to support verbal explanations with written information, use of white boards, anatomical atlas to illustrate procedures etc. This is especially important for post-operative home care information.
Veterinarians are expected to exercise sound professional judgement in determining who is able to consent to treatment. The client may be the owner of the animal, someone acting with the authority of the owner, or someone with statutory or other appropriate authority. If the person providing consent is not the owner, and has not confirmed their authority to act on behalf of the owner, procedures should only be carried out in exceptional circumstances. If there is any question about the person not being the owner or being an authorised representative, this must be documented.
If the owner is less than 16 years of age or has limited capacity to provide consent, veterinarians should consider whether someone else can assist in providing informed consent.
A person under the age of 18 (a minor) can provide informed consent to the treatment or procedure. However, the veterinarian should assess whether they think that person is competent to make such a decision, taking into account factors such as the complexity of the procedure and their apparent level of understanding.
The agreement to pay for the service (procedure or treatment) should be treated as a separate process to obtaining informed consent. An agreement to pay for the service may not be legally enforceable if the person is under the age of 18 years, even though it is acceptable for them to provide consent to proceed. Veterinarians will need to consider whether someone else can assist when setting up arrangements to pay for the work. This could be a parent, guardian, employer or friend.
If the owner is less than 18 years and cannot pay for the service at the time and if an older person is not available to take responsibility for payment, the veterinarian will need to make a judgement on how to proceed taking into account the animal's welfare. Questions which the veterinarian might need to consider include, for example:
what is the minimum amount of treatment needed which addresses the welfare of the animal at the time eg treating a fracture with a Robert Jones bandage, sedation and analgesia?
would the SPCA or another animal welfare charity accept responsibility for payment or part payment?
depending on the circumstances should euthanasia be considered?
is the practice prepared to take a risk to cover the cost and proceed on the basis that they believe the owner intends to pay?
It is recommended that the practice develop a policy setting out how their veterinarians can deal with these situations.
In discussing alternative treatment options veterinarians must not tailor the discussion because of their evaluation of the client's financial status. Failing to inform clients of reasonable medical alternatives (for example referral) breaches the Code.
Part of the discussion to obtain informed consent should include how the veterinarian can contact the client during the procedure to discuss unexpected outcomes. Veterinarians should also gain the client's agreement to act without further consent if it becomes necessary in the interests of the animal.