Nursing Law and Ethics

professional conflicts of disclosure. The nurse should note clause 5 of the UKCC
code which states that he or she should:

`work in an open and co-operative manner with patients ,clients and their

families ,foster their independence and recognise and respect their involvement

in the planning and delivery of care.'

It should be noted that while this chapter does give an introduction to the issues it
is obviously not possible to explore the full breadth and range of complex issues
which arise consequent upon consent to treatment; for a fuller exploration readers
are referred to other sources [4].

7.1 Consent to treatment ± some general issues

7.1.1 The consent form

One of the most frequent cries to be heard in a hospital is `have you got her consent
form?'. All nurses are familiar with the consent forms given to patients to sign
before they go in for an operation. But the fact that the patient has signed a consent
form does not by itself make that consent legally binding ± oral consent may be
perfectly valid. However ,while it is not strictly required ,written consent has the
advantage of drawing a patient's attention to the fact that she is consenting to a
clinical procedure and it may provide some evidence of her consent should there
be any future dispute as to whether consent was given.

7.1.2 Express and implied consent

While consent may be given expressly ,whether in writing or orally ,in some
situations even express oral consent is not required. If a patient proffers her arm
for a bandage to be applied ,although she may say nothing her actions imply that
she has consented to the procedure. But there are dangers in too readily assuming
that a patient has given implied consent. For example ,particular difficulties can
arise in relation to blood tests. When blood samples are taken ,a number of tests
are usually performed on the samples. It has been argued that by giving general
consent to a blood sample being taken a patient is consenting to all those tests
being performed which the doctor considers to be necessary [5]. But what if one of
those tests is to determine a patient's HIV status? Is this a test of a different nature?
It is clear that the implications for a patient if an HIV test is taken are considerable.
For example ,it may inhibit their ability to obtain insurance and employment. The
precise legal position as to whether blood can be tested for HIV without consent
remains uncertain. Different legal opinions have been expressed on this point [6].
The General Medical Council have stated in their 1997 guidance that consent must
be obtained from patients before testing for a serious communicable disease [7].
This guidance goes on to state that:

`Some conditions such as HIV ,have serious social ,financial ,as well as medical

implications. In such situations the nurse must make sure that the patient is

100 Nursing Law and Ethics