Consent should be an absolute in Healthcare

In two separate cases I have been involved in, it has been discovered that medical staff with a serious conflict of interest due to complaints against them (and therefore informed consent withdrawn), have continued to interject and pull strings behind the scenes in administrative matters.

In one case, the Central Legal Office (the people who represent NHS boards in Scotland) actively advised one member of the board to hide their identity from the patient in communications so they could continue to work on the case. Threats of legal action at the time of consent being withdrawn should have been enough to make these staff aware that they had no consent to act.

The excuse? They were merely performing administrative tasks.

Unfortunately, that excuse is not enough considering, at the conclusion of one of those complaints, the board in question was ordered to deliver a second opinion, however, the referral for that opinion left out, not only medications used to treat underlying medical conditions but also the underlying medical conditions the medications were used to treat.

When the receiving physician (of the referral) at another board was made aware of the missing information, they immediately dropped the referral citing a conflict.

Which raises a serious set of questions – why is it acceptable for persons under complaint (the ones who made the mistakes) to interject when there is such a serious conflict of interest – especially when that leads to the destruction of a mandated second opinion which was intended to resolve the issue?

Consent should be absolute and when it is withdrawn, it should apply to all aspects of the patient’s healthcare – unfortunately, it is a grey area and in these cases it resulted in the misrepresentation of clinical status to other healthcare professionals, seemingly to try and have them render an opinion in the blind without the proper empirical data on which they rely upon to render a fair and unbiased medical opinion.

As a candidate for the 2021 elections, I am pledging to put forward legislation to improve the referrals system, but also to enshrine informed consent as an absolute, when withdrawn, it applies to ALL aspects of person healthcare – with enforcement processes.

Unfortunately, this story is becoming all too common and seems most prevalent in the more senior administrative staff of NHS boards. It not only causes severe distress to the patient but also destroys the patient/doctor relationship – after all, how can the patient trust doctors who come after when such things occur.

It’s time to realise, in legislation, that the patient/doctor relationship is one with a substantive power imbalance. It requires absolute trust between patient and doctor, and the patient to acquiesce to the doctor, purely on the basis that they should trust that doctor – but when that trust is broken, it has profound consequences for the patient, medically and psychologically. That needs to be recognised and it needs to be defined unambiguously in legislation.

If a person is told by another person to stay away from them but continues to harass them, we’d call that stalking. In my view, with respect to the doctor-patient relationship, it is worse, because the patient has trusted that doctor during a time in their life where they are at their most vulnerable. To continue to push themselves upon the patient is unforgivable. We would not accept it if it were a medical procedure, indeed a doctor would be subject to charges of assault against the patient if they were to do so.

The psychological effects of interjections, even in administrative matters, particularly when there are negative results from it, should be given the same weight as the physical and psychological harm of performing a procedure without consent.

We recently passed laws in Scotland with respect to coercive behaviour of partners to their spouse, the doctor/patient relationship is just as intimate as a sexual one. We must hold medical staff to a much higher standard than others, just as we do in all other fields where there is a power imbalance.

The irony is that the law does not give specific provisions for doctors in this regard, it does, however, have rules about legal professionals acting in such a manner. A solicitor or other legal counsel can lose their license for acting in such a manner. Yet seemingly there are no such specific provisions for the more intimate relationship of Doctor/Medical Professional/Patient. That needs to end!

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