ScenarioImplied / Express Consent

Implied Consent for a Change in a Diet Order

You work as a dietitian in a hospital and speak with a client about a change to their diet order. You have a good discussion about the client’s goals and together, you agree on a nutrition plan. At the end of the meeting, you say, "The diet changes will be initiated for you starting tomorrow at breakfast.” As you leave, you realize that the client never actually said yes. However, you are sure that they agreed to the change. Should you go back and get an express consent?

In this scenario, an express consent may not be necessary for the consent to be valid.  If the risk involved in the diet change is minimal, relying on the client’s implied consent may be sufficient. A dietitian needs to use their professional judgment (Refer to the Professional Practice Standard, Consent to Treatment, When to Rely on Express or Implied Consent, p.4). However, if a risky intervention is recommended, or if a client appears unreliable, then written express consent can help a dietitian be confident that an informed consent was obtained.  

While express consent is not always required, dietitians need to be sensitive and confident that they have actually obtained consent. Remember that written consents are not a complete defense against an allegation of failing to obtain consent. A written consent should not be confused with the process of obtaining an informed consent.  A signed consent form is simply a piece of paper, unless it is read and fully understood by the client.  (Refer to the Professional Practice Standard, Consent to Treatment, p.12).