1. Purpose
This policy sets out how the Service obtains valid, voluntary, informed consent for termination of pregnancy and how it manages reflection time and capacity assessment.
Termination consent is held to a higher communication standard than most clinical procedures because of the gestational-age dependency, the statutory framework, and the particular sensitivity around coercion and capacity.
2. Sources to verify before adoption
- Abortion Act 1967: https://www.legislation.gov.uk/ukpga/1967/87
- GMC, Good Medical Practice 2024: https://www.gmc-uk.org/professional-standards/good-medical-practice-2024
- GMC, Decision making and consent: https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent
- Royal College of Obstetricians and Gynaecologists, Best practice in abortion care: https://www.rcog.org.uk/guidance/browse-all-guidance/other-guidelines-and-reports/best-practice-in-abortion-care/
- Mental Capacity Act 2005: https://www.legislation.gov.uk/ukpga/2005/9
- Montgomery v Lanarkshire Health Board [2015] UKSC 11: https://www.supremecourt.uk/cases/uksc-2013-0136.html
- NHS, "Consent to treatment — children and young people": https://www.nhs.uk/conditions/consent-to-treatment/children/
- General Medical Council, 0-18 years: guidance for all doctors: https://www.gmc-uk.org/professional-standards/the-professional-standards/0-18-years
3. Scope
This policy applies to:
- All patients presenting for a termination consultation, whether medical or surgical pathway.
- Patients aged 16 and over (presumed competent to consent).
- Patients aged under 16 (Fraser-competence assessment required — see §7).
- Patients where capacity is in question for any reason (cognitive, mental health, intoxication, language).
- Consent for the termination itself + consent for any incidental procedures (anaesthesia, follow-up imaging, blood testing, contraceptive provision, tissue retention).
4. The consent conversation
A trained clinician conducts the consent conversation. The discussion covers:
- The patient's gestational age, confirmed by ultrasound where clinically indicated.
- The available treatment pathways at the patient's gestational age (medical, surgical, or both).
- The procedure for each pathway: what happens, where, by whom, how long.
- Material risks of each pathway, including the risk of incomplete termination and continuing pregnancy.
- Likely physical experience during and after the procedure.
- Alternatives, including continuing the pregnancy and the support routes for each alternative.
- Aftercare, follow-up, and how to access urgent help if complications arise.
- Contraception options for the future.
The clinician answers the patient's questions. The Service does not impose a minimum number of conversations; one conversation is sufficient if the patient is clear, but the patient may take additional reflection time at their request (§5).
5. Reflection time
The Abortion Act 1967 does NOT impose a statutory cooling-off period. The Service's policy is to:
- Offer the patient as much reflection time as they want, including overnight or longer.
- Never pressure a patient to confirm a decision in the consultation.
- Document the reflection offered and the patient's choice on the consent record.
Where the patient explicitly states they have already reflected and want to proceed, the Service does not require an artificial delay. Adding a delay against the patient's wishes is itself a violation of patient autonomy.
6. Capacity assessment
Capacity is assumed in adults aged 16 and over unless there is reason to believe otherwise (Mental Capacity Act 2005, sections 1-3).
Where capacity is in doubt, the assessing clinician documents:
- The specific decision being assessed (capacity is decision-specific, not blanket).
- The information given to the patient.
- Whether the patient can understand, retain, weigh, and communicate the decision.
- The conclusion (capacity / no capacity for this decision).
If the patient is assessed as lacking capacity for this decision, the termination cannot proceed on the basis of their consent. The Service follows the best-interests pathway under the Mental Capacity Act 2005 and consults with the patient's representatives or seeks judicial input where appropriate. The Service's clinical lead is involved in every such case.
7. Patients under 18
7.1 Patients aged 16 and 17
Presumed competent to consent. Parental involvement is encouraged but not required. The Service applies the same consent standard as for adults. Safeguarding considerations may still apply (see safeguarding policy).
7.2 Patients aged under 16
The Service applies the Fraser guidelines. The assessing clinician documents:
- That the patient understands the information, advice, and consequences.
- That the patient cannot be persuaded to inform their parents.
- That the patient is likely to begin or continue sexual activity with or without treatment (where relevant).
- That the patient's physical or mental health is likely to suffer if they do not receive the treatment.
- That treatment is in the patient's best interest.
Where any element of Fraser competence is not met, the Service does NOT proceed on the patient's sole consent and follows the safeguarding pathway.
7.3 Patients under 13
Patients under 13 are not legally able to consent to sexual activity. Any patient presenting under 13 is referred under the child-safeguarding pathway in the safeguarding policy. The clinical question is then secondary to the safeguarding response.
8. Coercion screening
Every consent conversation includes screening for coercion or pressure from a partner, family member, or third party. The Service's clinicians are trained to:
- Ask the question directly when there is any cue.
- Provide an opportunity for the patient to be seen alone if accompanied.
- Recognise non-verbal cues of pressure (eye contact, body posture, who answers questions).
Where coercion is disclosed or suspected, the safeguarding policy applies.
9. Information provision
The Service provides written information to the patient covering:
- The treatment pathways available at the patient's gestational age.
- Material risks of each pathway, with comparative figures where reliable data exists.
- Aftercare and follow-up.
- Contraception options.
- Patient confidentiality and data protection (see separate policy).
- How to access urgent help if complications arise after discharge.
Patient-facing written information is reviewed annually by the Service's clinical lead and is updated whenever clinical evidence or regulatory guidance changes.
10. Documenting consent
The consent record includes:
- The clinician who took consent and their professional registration number.
- The gestational age confirmed.
- The pathway consented to.
- The risks discussed, in summary.
- The reflection time offered and chosen.
- The capacity assessment outcome.
- The Fraser assessment outcome (where applicable).
- Any coercion screening result.
- The patient's signature.
Consent records are retained per the Service's records retention policy and the Abortion Regulations 1991 retention requirements.
11. Training
All clinicians taking consent for termination complete:
- Induction training on Abortion Act statutory grounds.
- Annual refresher on Mental Capacity Act 2005 + Fraser competence.
- Coercion screening communication training (initial + biennial refresher).
12. Review
This policy is reviewed at least annually and whenever GMC consent guidance, RCOG best-practice guidance, or the Abortion Act 1967 materially changes.