Putting shared decision making into practice

Lawyer Richard Griffith explains how healthcare assistants can make 'no decision about me, without me' a reality for patients

Standard 2 of the revised NMC Code emphasises the importance of listening to people and responding to their preferences and concerns. The standard reflects a new approach to promoting autonomy and bodily integrity underpinned by the principle of 'no decision about me, without me'.

NHS policy and obligations under the new Code emphasise a partnership with patients and a desire to ensure that patients are involved in decisions about their provider, place and form of treatment by:

• Working in partnership with people to make sure care is delivered effectively.
• Recognising and respecting the contribution that people can make to their own health and wellbeing.
• Encouraging and empowering people to share decisions about their treatment and care.
• Respecting the degree to which patients want to be involved in decisions about their health, and care.
• Respecting, supporting and documenting a person’s right to accept or refuse care and treatment.
• Recognising when people are anxious or in distress and respond compassionately and politely.

Healthcare assistants have a duty to ensure that patients have sufficient information about their proposed care and alternatives before they obtain consent to proceed. This duty to provide information about treatment and care options in a spirit of partnership was recognised by the Supreme Court in Montgomery v Lanarkshire Health Board. The Court found that greater importance was now attached to personal autonomy, and when asked to decide about treatment that might have an effect on their health and wellbeing, patients were entitled to information about risks and alternative treatment.

There is now a legal as well as a professional duty to ensure that patients are aware of the material risks involved in any treatment recommendations and reasonable alternatives.

Health support workers must provide patients with the information needed to make an informed decision about their care and treatment, ensuring that 'no decision about me, without me' is a reality in the NHS.

About the author

Richard Griffith is lecturer in law at University of Swansea