For any practising veterinarian, obtaining informed consent is an important step before proceeding with an important treatment, especially surgery. However, what constitutes "informed consent"? Practically speaking, what does obtaining "informed consent" actually look like?
Two recent decisions from the discipline committee of the College of Veterinarians of Ontario are helpful to this discussion: Dhaliwal v. College of Veterinarians of Ontario, 2025 ONSC 1931 (CanLII) ("Dhaliwal") and Ontario (College of Veterinarians) v Dua, 2024 ONCVO 9 (CanLII) ("Dua").
To briefly review the issues in each case:
- In Dhaliwal, three complaints from different dog owners were made against Dr. Dhaliwal. This blog post will focus on the "Mehrotra" complaint, which concerned a 12-year-old Jack Russell Terrier, Chiko, who was suffering from a liver tumour. Dr. Dhaliwal performed liver lobectomy surgery on Chiko.
- In Dua, the complaint revolved around treatment for a nine-year-old Great Dane, Titan, that was suffering from a bleeding bump on his tail. Titan's owners brought him to Dr. Dua, who recommended and performed a tail docking (amputation) procedure.
These two decisions provide three important takeaways on the topic of informed consent.
1) Informed Consent Requires an Informed Veterinarian
First, a veterinarian should ensure that they have all the information needed to have an informed consent discussion.
In Dua, Dr. Dua recommended a tail docking (amputation) procedure for the dog's bleeding bump issue. Importantly, Dr. Dua did not take any steps to contact the dog's prior treating veterinarians or obtain the dog's medical history. Dr. Dua also did not take steps to obtain the dog's relevant bloodwork prior to anesthetizing him, even though Titan was a senior dog. The Panel held that Dr. Dua should not have proceeded to surgery relying exclusively on the owners' word that Titan's recent bloodwork was within normal limits. The Panel therefore found that Dr. Dua had insufficient information about the dog prior to the surgery, including in particular the dog's recent bloodwork results. As a result, Dr. Dua was missing information that he himself would have needed in order to have a proper informed consent discussion with the dog's owners. Accordingly, Dr. Dua was found to have failed to obtain informed consent for the treatment.
The Dua decision highlights the importance of gathering all important information so that a proper informed consent discussion can take place.
2) A Signed Consent Form Is Not Necessarily Informed Consent
Second, a generic consent form may not be enough to constitute informed consent.
As stated by the Panel in Dua, "consent is more than a form, it is a process" (paragraph 134). In Dua, Titan's owners had signed a surgical consent form. However, the Panel found that the consent form was insufficient because it did not adequately detail the risks of the proposed procedure. Similarly, in Dhaliwal, the Panel considered that Dr. Dhaliwal's reliance on generic consent forms was inadequate in providing owners with the proper information upon which to provide true informed consent.
In sum, a signed consent form does not necessarily equate to truly informed consent.
3) Consent Discussions Should be Documented
Third, any verbal informed consent discussions should be documented in some manner in a veterinarian's records.
In Dhaliwal, the 12-year-old Jack Russell Terrier, Chiko, was suffering from a liver tumour. Chiko's owner brought him to veterinarian, Dr. Afzal. Dr. Afzal then referred the owner to Dr. Dhaliwal for liver lobectomy surgery on Chiko. Dr. Dhaliwal did not have any discussions with Chiko's owner about the procedure and went ahead with the surgery. Chiko unfortunately died approximately a week after the surgery. Dr. Dhaliwal stated that he relied on Dr. Afzal to discuss all necessary details with Chiko's owner. However, the Panel found Dr. Dhaliwal's notes were scant and provided little insight as to what, if any, conversations he had with Dr. Afzal or others. The Panel found that Dr. Dhaliwal had failed to obtain informed consent from the owner, and this was upheld on appeal.
Similarly, in Dua, Dr. Dua testified that aside from the owners signing a generic consent form, he had also had a more detailed discussion about the treatment with the owners. However, this alleged discussion was not documented. Titan's owners denied that such a discussion took place and instead testified that there was minimal discussion with them of the risks of the procedure, including that their dog could die. The Panel ultimately preferred the testimony of the owners.
These decisions highlight the importance of creating contemporaneous records to support that informed consent discussions took place.
Conclusion
The Dhaliwal and Dua decisions are important reminders that informed consent is not just a signature on a form. Further, failing to obtain informed consent can have serious consequences, not only for the patient but also for the veterinarian's professional standing. Good legal counsel can assist you in navigating complex issues around informed consent.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
