Use this pack when the decision matters enough that you do not want to rely on memory, pressure, reassurance, or a vague sense of having “been told.”
This pack is for significant decisions. Use the shorter Consent Pause List when you need a quick 3–5 minute bedside check. Use this pack when the decision is complex, emotionally difficult, disputed, time-sensitive, involves capacity concerns, or needs a written record.
Do not use this pack to delay urgent or emergency care. If the situation is urgent, ask for the clearest explanation possible, but do not let paperwork become a barrier to necessary emergency action.
Boundary note: this is public education and decision-support guidance. It is not legal advice, clinical advice, diagnosis, treatment, prescribing, or a substitute for speaking with the appropriate professional. LPA/EPA wording is focused on England and Wales; Scotland and Northern Ireland use different systems.
Start here
Decision snapshot
Basic details
Capture the situation before the details scatter. This gives the decision a clear frame.
What is proposed
What exactly is being recommended?
The proposal in plain English
Do not settle for a label. Write what is actually being suggested and why.
Benefits, risks, burdens
What is the trade-off?
Expected benefit
A benefit should be relevant to this person, not just generally true.
Risks, harms, burdens, and uncertainty
Risk is not just rare serious harm. It can include side effects, recovery burden, follow-up, interactions, uncertainty, discomfort, inconvenience, and what the decision asks the person to carry afterwards.
Other options
Alternatives — including waiting or doing nothing
Reasonable alternatives
A person cannot compare a decision properly if only one path has been explained.
If “there are no alternatives” is said
Ask whether there are truly no alternatives, or whether one option is strongly recommended because it is safest or most appropriate. A narrow choice can still be an informed choice if the reason is clearly explained.
What this decision does not include
Consent has boundaries. Write down what the person is agreeing to — and what they are not agreeing to — so the decision does not silently expand later.
Timing and pressure
Is this urgent, or is there time to think?
Urgency check
Pressure can come from clinical urgency, system pressure, emotional stress, or the person’s fear of being difficult. Separate those out.
Decision confidence score
Choose the closest score before finalising. Low confidence does not always mean “do not proceed” — but it does mean the reason for proceeding should be clear, especially if the situation is urgent.
Green / amber / red decision state
Green
Clear enough to decide: proposal, reason, risks, alternatives, timing, capacity/support, and follow-up are understood.
Amber
Proceed carefully or pause if safe: some questions remain, or the decision needs review, support, written explanation, or clearer ownership.
Red
Pause and clarify if safe: major uncertainty, pressure, capacity concern, legal-authority confusion, or unresolved disagreement.
Capacity and understanding
Can the person make this decision now?
Capacity is decision-specific and time-specific
This pack does not assess capacity. It helps families and supporters notice when capacity, understanding, timing, or support may need to be discussed properly.
Capacity is not a blanket label
A person may be able to make one decision but not another. A simple decision and a complex decision may require different levels of understanding.
Capacity can fluctuate
Understanding can change with delirium-like confusion, infection, pain, medication, sleep loss, unfamiliar environments, distress, hearing, vision, and time of day.
The supporter’s role
A supporter does not automatically become the decision-maker. Their role is often to help the person understand, represent baseline and wishes, notice change, ask for clarity, and ensure the right legal authority is checked if the person cannot decide.
Legal authority and documents
LPA, EPA, advance decisions, and what to check
Document check
This is not legal advice. It is a practical prompt to stop families assuming that “power of attorney” automatically means health-decision authority.
England and Wales prompt: there are two types of Lasting Power of Attorney: Health and Welfare, and Property and Financial Affairs. A Health and Welfare attorney may be relevant to medical or care decisions, but only when the person lacks capacity for that decision. An older Enduring Power of Attorney may still be valid for property and financial affairs, but it is not the same as a Health and Welfare LPA.
If the loss of capacity may become permanent
Do not leave this vague. Ask what process will be used for future decisions, who will be consulted, whether any LPA/EPA/advance decision exists, how best-interests decisions will be recorded, and whether specialist legal advice is needed for complex or disputed situations.
Who can decide today?
This simple triage prevents a common confusion: being close to the person is not the same as having legal authority, and having financial authority is not the same as health and welfare authority.
If there is disagreement
Disagreement does not always mean conflict. It may mean the facts, risks, values, capacity, authority, or follow-up responsibility have not been made clear enough yet.
Documents to collect or ask for
A strong decision record includes the documents that explain what was agreed, what risks were discussed, and what happens next.
Questions asked
Questions, answers, and remaining gaps
Question record
This is where the pack becomes evidence of understanding, not just a memory aid.
Repeat-back record
Repeat-back catches misunderstandings before they become decisions.
Repeat-back script
- “What I understand is that you are recommending [this] because [reason]. The main benefit is [benefit]. The main risks or downsides are [risks]. The alternatives are [alternatives]. If we wait or do nothing for now, [consequence]. Is that correct?”
Decision record
The decision made
Record the decision clearly
A good decision record does not just say what was chosen. It records why, what remains uncertain, and what happens next.
After the decision
Decision aftercare
What happens after agreement?
Consent does not end at yes. A good decision includes what happens next, what should be monitored, and when the decision should be reviewed.
Follow-up and ownership
Who owns the next step?
After the decision
Many consent problems appear later because nobody knows who owns review, monitoring, results, side effects, or escalation.
If nobody owns the next step
Ask before leaving the conversation: “Who is responsible for this from here, and when should we expect the next update or review?”
Final decision summary
Use this short summary if you need to email, print, share with family, take to the GP, or return to the hospital conversation.