What good consent looks like

6.2.1Consent as a process

The model set out in professional guidance is not complicated. The clinician establishes what the patient wants to achieve and what matters to them. They explain the options, including the option of doing nothing. They discuss the risks that would be material to this person, which means the risks this particular patient would want to know about rather than a standard list. They check that the information has been understood. They allow time. And they recognise that consent can be withdrawn at any point.

The General Medical Council's guidance on decision making and consent sets this out for doctors, and equivalent standards apply across the other registered professions. The guidance is public, is written in plain language, and is worth reading by a patient as well as by a clinician.

6.2.2Material risk, and why the standard list fails

Material risk is defined by reference to what this patient would consider significant, not by reference to how common a risk is. That is a meaningful distinction with practical consequences.

A person who works in front of a camera has a different relationship to a week of visible bruising than someone who works from home. A person with a history of anxiety about their appearance has a different relationship to the possibility of prolonged swelling. A person who has previously had a bad experience with an injectable has a different relationship to the absence of a reversal agent.

None of that can be captured by a printed list. It requires the clinician to have found out something about the person in front of them, which is why the earlier parts of a consultation are not preliminaries.

6.2.3Why the standard is higher for cosmetic procedures

Because the balance is different. In clinical medicine there is a condition that needs addressing and doing nothing carries its own cost. In elective cosmetic treatment there is no clinical need, doing nothing costs nothing medically, and the person is paying for a service from the person advising them.

Professional guidance on cosmetic practice recognises this and adds specific expectations: that the practitioner performing the procedure is responsible for the consent discussion rather than delegating it, that psychological factors are considered, that patients are given time, and that the practitioner is prepared to decline.

6.2.4The items specific to this treatment

Beyond the general framework, a consent discussion for polynucleotide treatment should cover four things that are particular to it.

• There is no reversal agent. Unlike hyaluronic acid, an unwanted result cannot be dissolved, and the response is time and symptomatic management.
• The central claim is not established. Whether an effect persists beyond the clearance of the material is unresolved. A patient paying for a course on the strength of a regenerative claim is entitled to know that.
• The product is fish derived. Relevant for allergy, and relevant for diet and belief.
• No visible change is a possible outcome. Not a complication, not a failure of technique, just a possible result.

If none of those four was mentioned to you, the consent conversation did not cover what is distinctive about this treatment, whatever else it covered.

6.2.5Signals that consent was not obtained properly

• The form was presented at the end and signed without its contents being discussed.
• The consent conversation was conducted by someone other than the person treating you.
• You were in the treatment chair, gowned or with anaesthetic already applied, when consent was taken.
• Risks were mentioned quickly, in a tone indicating that they were a formality.
• You asked a question and received reassurance rather than an answer.
• You were told you could not think about it because of a price that expires.
• The option of doing nothing was never presented as an option.

6.2.6Withdrawing consent

You may withdraw consent at any point, including after treatment has begun. Saying that you would like to stop is always available to you and it does not require a justification. A practitioner should stop.

This is worth stating explicitly because people find it very difficult to do in practice. Social pressure in a treatment room is considerable, particularly when someone has already begun, and knowing in advance that stopping is a right rather than an imposition makes it easier to exercise.

6.2.7Consent and what happens afterwards

If something goes wrong, the adequacy of the consent process becomes relevant in a different way. A complication that you were told about and accepted is a different matter from a complication that was never mentioned. This is one of several reasons to keep the written information you were given, and to note at the time what was discussed.

That said, the reason to want a good consent process is not litigation. It is that a decision made with the relevant information is a decision you are more likely to be content with afterwards, whichever way it goes and whatever the result.