O&G · Professional practice — ethics, consent and communication
Consent and shared decision-making
Also known as Informed consent · Shared decision-making · Montgomery consent · Material risk · Capacity assessment · Mature minor consent · Advance care directive · Substitute decision-making
Exam-exhaustive FRANZCOG professional reference on the four-principles framework, consent as a shared decision, Montgomery and Rogers material-risk standards, capacity, documentation, adolescents, patients lacking capacity, advance directives, emergency consent and culturally safe practice.
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Red flags
- The patient has signed but cannot explain the procedure, alternatives or personally material risks — the process is incomplete
- A partner answers every question or interprets — speak privately with a qualified interpreter and assess voluntariness
- An apparently unwise refusal is being labelled incapacity — disagreement is not a capacity test
- Treatment is proposed for an incapable patient without checking an advance directive or lawful decision-maker
- The patient withdraws consent at the theatre door — stop; a signature does not survive withdrawal
- Culture is used to speak to family instead of the patient — collective discussion never erases the patient's authority
It is 07:45 outside theatre. A patient booked for hysterectomy looks at the form and says, “I signed because everyone seemed to expect it, but I do not want to lose my fertility.” The safe registrar does not reach for a pen. You stop the conveyor belt, give the patient time and privacy, and rebuild the decision from her goals outward. That is shared decision-making.[1][5]
Overview and definition
Informed consent is a continuing process through which a person with capacity makes a voluntary choice after receiving and understanding information relevant to that choice. The patient may accept, refuse or withdraw at any time. Written consent documents the process; it does not create it.[1][4][6]
Shared decision-making is the clinical method that makes consent real. You contribute diagnosis, evidence, uncertainty and feasible options. The patient contributes goals, risk tolerance, culture, family context and lived experience. The decision sits where those two forms of expertise meet.[6][10]
References12ShowHide
- [1]Royal Australian and New Zealand College of Obstetricians and Gynaecologists Consent and provision of information to patients regarding proposed treatment (C-Gen 2) RANZCOG, 2026.Source
- [2]High Court of Australia Rogers v Whitaker (1992) 175 CLR 479 High Court of Australia, 1992.Source
- [3]Supreme Court of the United Kingdom Montgomery v Lanarkshire Health Board [2015] UKSC 11 UK Supreme Court, 2015.Source
- [4]Health and Disability Commissioner Code of Health and Disability Services Consumers' Rights New Zealand Government, 1996.Source
- [5]Medical Board of Australia Good medical practice: a code of conduct for doctors in Australia Medical Board of Australia, 2020.Source
- [6]General Medical Council Decision making and consent GMC, 2020.Source
- [7]Dathatri S, Gruberg L, Anand J, et al. Informed consent for cardiac procedures: deficiencies in patient comprehension with current methods Ann Thorac Surg, 2014.PMID 24629303
- [8]Wada K, Charland LC, Bellingham G Can women in labor give informed consent to epidural analgesia? Bioethics, 2019.PMID 30358905
- [9]Teshome M, Wolde Z, Gedefaw A Surgical informed consent in obstetric and gynecologic surgeries: experience from a comprehensive teaching hospital in Southern Ethiopia BMC Med Ethics, 2018.PMID 29793471
- [10]Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice J Gen Intern Med, 2012.PMID 22618581
- [11]Stacey D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions Cochrane Database Syst Rev, 2017.PMID 28402085
- [12]National Health and Medical Research Council National Statement on Ethical Conduct in Human Research NHMRC, 2023.Source