Meaningful choices: consent to treatment in general health care settings for people with learning disabilities

Abstract

A small scale qualitative research project explored the experiences of I3 learning disabled people receiving care and treatment in general hospital settings. Using grounded theory to analyse the data, the question of consent to treatment emerged as an area of significantly varying practice. Some respondents reported that they were forbidden to sign consent for their own operation, whereas others who could have been deemed able, opted to let a significant other sign on their behalf. Evidence suggests that consent is primarily being sought as a legal requirement, and rarely as a strategy for ensuring people with learning disabilities understand the nature of their forthcoming treatment. One respondent reported that his attempt to withdraw consent for treatment was ignored. The respondents had received treatment in a total of seven different hospitals, all of which emerged as having markedly different approaches to obtaining consent from patients with learning disabilities. The current attention addressing the health care needs of people with learning disabilities, bolstered by the publication of 'Signposts for Success' (NHS Executive I998) last year, is welcomed. But if such work is to make a significant contribution to the well-being of people with learning disabilities then it must run in tandem with developments in the understanding of consent. Ultimately this must lead to the introduction of practices that respect the wishes of people with learning disabilities, and are enabling, at the same time ensuring that action is taken, where necessary, in the best interest of others. Recommendations include the need for additional training for general hospital staff and, where possible, the involvement of learning disability nurses in preparing people for planned admissions.