The nurse must ensure that sufficient information has been given in terms readily
understandable to the patient so as to enable him to make a truly informed
decision. It is for the nurse to state this opinion and to seek to have the situation
remedied. The practitioner might decide not to cooperate with a procedure if
convinced that the decision to agree to it being performed was not truly
informed. [67]
But while the nurse may remonstrate with the doctor ,what if the doctor ignores
her views? The UKCC states that:
`There is potential for disagreement or even conflict between different profes-
sionals and relatives over giving information to a patient or client. When dis-
cussing these matters with colleagues or relatives ,you must stress that your
personal accountability is firstly to the patient and client. Any patient or client can
feel relatively powerless when they do not have full knowledge about their care or
treatment. Giving patients and clients information helps to empower them. For
this reason ,the importance of telling the truth cannot be over-estimated.' ?p. 16)The nurse may decide not to participate in a clinical procedure on the grounds that
the patient has been inadequately informed ,or she may decide to provide the
patient with more information herself. But in taking either step she risks
disciplinary proceedings and ultimate dismissal for disobeying orders [68].
In addition ,in deciding to go ahead and disclose ,the nurse runs the risk that her
assessment of the amount of information the patient requires may be wrong. What
if the patient is unable to cope with the information given and suffers a nervous
breakdown? An action may be brought against the nurse claiming that she was
negligent in disclosure. Whether such an action would succeed would depend on
the test employed by the court. It is submitted that a court would assess whether
she had acted negligently in disclosing ,by reference to a professional body of
nursing opinion.
Anurse may protest to a doctor that a patient has not been given sufficient
information but on being told by the doctor to obey orders she may decide not to
give the patient more information about treatment risks. But what if the treatment
risk materialised and the patient suffered harm? Any negligence action for failure
to provide adequate information would probably be brought against the doctor
rather than the nurse [68]. If an action was brought against the nurse it might not
succeed. In the past the courts have held that as long as a nurse is following doctors
orders she will not be held liable ?Pickeringv.Governors of United Leeds Hospitals
?1954)). But with the development of the role of the nurse as an autonomous
practitioner and as advocate for her patient ,this situation may change. If such an
action was brought ,a court would have to consider whether in remaining silent
she had acted in accordance with a responsible body of professional nursing
opinion [69].
It has been suggested that a nurse may be found liable if she undertakes a task
under instructions which she believes to be `manifestly wrong' [68] ,following
comments made by the House of Lords inJunorv.McNichol?1959). It is possible
that participation in treatment of a patient who has not been told of a very high risk
of death or serious injury would come within this category. However ,this would
presumably only arise in the most exceptional case.
Consent and the Capable Adult Patient 117