When capacity to consent is in question: a practical framework for radiographers

Consent in clinical practice is a complex but important topic. A new flowchart is helping to simplify the process of obtaining consent for radiographers

A central tenet of clinical practice is to obtain informed consent from patients. For this consent to be considered legally valid, it must be given voluntarily and be adequately informed, and the individual must possess decision-making capacity (1). Of these elements, it is the assessment of capacity that appears to present the greatest challenge for diagnostic radiographers in clinical practice (2). This is of particular significance as proceeding without valid consent may expose practitioners to allegations of trespass to the person, assault or battery (3). Whether a person has capacity depends on their ability to make a specific decision at the time it needs to be made, rather than a fixed or general ability (4). Therefore, a lack of capacity may arise for a number of reasons, some of which may be permanent – for example, stroke, head injury or late-stage dementia – and some temporary, like the effects of certain medications or alcohol. In the context of diagnostic imaging, such conditions are frequently encountered, meaning that radiographers are regularly required to consider questions of capacity in clinical practice. However, the uncertain fixity and duration of these impairments present a distinct set of practical, legal and ethical considerations, which our previous research has identified as particularly challenging for radiographers (5).

References:
1. Hassan M. Informed consent and the law – an English legal perspective. Digestive Diseases 2008;26:23–27. doi: 10.1159/000109381.
2. Miller PK, Booth L and Spacey A. Dementia and clinical interaction in frontline radiography: Mapping the practical experiences of junior clinicians in the UK. Dementia 2019;18:1010–1024. doi: 10.1177/1471301217700742.
3. Bond E and Gardner J. Rethinking ‘Negligence’ in ‘Medical Negligence’: Can Trespass to the Person Torts Help Protect Autonomy?. In: Horsey K (ed) Diverse Voices in Tort Law. Bristol: Bristol University Press, 2024, p.201.
4. Social Care Institute for Excellence. Mental Capacity Act 2005 at a glance, https://www.scie.org.uk/mca/introduction/mental-capacity-act-2005-at-a-glance/.
5. Spacey A, Booth L, Bowden SLJ and Miller PK. Exploring diagnostic radiographers’ experiences and understandings of informed consent and capacity assessment during general radiography imaging examinations of persons living with dementia: A qualitative interview study of UK practice. Radiography 2026;32:103309. doi: 10.1016/j.radi.2025.103309.