Ok, the two key resources are the government's guidance on consent and the GMC guidance on consent.
The government's guidance can be found in full here:
www.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf
The GMC's guidance on consent can be found in full here:
www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_contents.asp
There are a couple of very basic principles that both tackle and in essence they are the same though worded slightly differently. The first is to address the balance of power between patient and practitioner, which automatically lies with the HCP and the second is to establish and maintain trust between patient and practitioner which is essential to ensure that the patient receives the best possible care for their individual and unique needs.
In order to do this, there is an emphasis on the involvement of the patient in the decision making process and good communication.
In all circumstances you retain the right to refuse treatment, if you are mentally capable to do so, and there are few circumstances that this applies. Even if you have mental health problems you can still have capacity to consent or refuse consent and there are ways to ensure your consent is respected even if you have a temporary restriction to your capacity.
Anyway, the really key points which need particularly stressing when it comes to intimate examinations and women are these:
From the government guidance
1.10. To be valid, consent must be given voluntarily and freely, without pressure or undue influence being exerted on the person either to accept or refuse treatment. Such pressure can come from partners or family members, as well as health or care practitioners. Practitioners should be alert to this possibility and where appropriate should arrange to see the person on their own in order to establish that the decision is truly their own.
In other words, if you feel pressured into consenting to anything by a HCP then the HCP is on dodgy ground. They should do everything possible to make YOU feel comfortable. It is not about THEIR comfort and THEIR values and beliefs. If you feel pressured there is a problem. There is no grey area here. It either means that the HCP has unintentionally made you feel pressured which is bad or that they have deliberately pressured which is worse. Both scenarios need to be addressed.
The GMC guidance states the following:
3. For a relationship between doctor and patient to be effective, it should be a partnership based on openness, trust and good communication. Each person has a role to play in making decisions about treatment or care.
4. No single approach to discussions about treatment or care will suit every patient, or apply in all circumstances. Individual patients may want more or less information or involvement in making decisions depending on their circumstances or wishes. And some patients may need additional support to understand information and express their views and preferences.
5. If patients have capacity to make decisions for themselves, a basic model applies:
a. The doctor and patient make an assessment of the patient’s condition, taking into account the patient’s medical history, views, experience and knowledge.
b. The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice.
c. The patient weighs up the potential benefits, risks and burdens of the various options as well as any non-clinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which one. They also have the right to accept or refuse an option for a reason that may seem irrational to the doctor, or for no reason at all.
d. If the patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.
Note here that you can refuse consent for ANY reason or no reason, whether the doctor considers this irrational or is at odds with their own personal beliefs. They can not impose their beliefs on you.
Since this guidance was all written there has been an important legal case, and I believe the guidance is currently under review (probably as a direct result of the ruling).
There used to be precedence called the Bolam Test, which stated that "If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent".
In 2015 there was a case where a woman got a ruling from the Supreme Court regarding informed consent. She had diabetes and gave birth by vaginal delivery. Her baby, was born with serious disabilities after shoulder dystocia during delivery. The doctor did not tell the woman of the 9-10% risk of shoulder dystocia.
As a result doctors must now ensure that patients are aware of any “material risks” involved in a proposed treatment, and of reasonable alternatives. It basically shifts the emphasis from the 'reasonable doctor' to the 'reasonable patient'.
Thus, if it is reasonable for a person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it, then they should be informed.
If you want to put this in the context of a woman whom has requested a female HCP. It is reasonable to assume that the patient might be sensitive to being treated by a male or indeed someone they might regard as male. Thus handling consent where a clear preference has been stated has to be treated with the highest possible amount of sensitivity. It is not acceptable for this woman to be put into a position where she might feel compelled or pressure to under go treatment against her previously stated preferences.
She can not been deemed to lack capacity to consent even if she suffers from anxiety or PTSD. Conversely, this reasonably creates an assumption that should automatically be respected that this woman is more vulnerable because of the request and her health needs and there shouldn't be an assumption that she can simply be assertive if put into a position which is at odds with her original request.
The reason that this is all is important is because of the need for trust in the relationship between HCP and patient. It recognises that the power lies with the HCP and its the HCP's responsibility to ensure that they have properly communicated and informed a patient. Their own personal feelings and beliefs come AFTER those of the patient. The patients feelings and beliefs should be respected as they underpin trust.
A breach of trust can mean that a patient's relationship with a HCP is damaged. This could impact on whether they get the best possible healthcare for their circumstances. It could endanger their wellbeing, because they no longer feel they can trust what they are told by HCPs. This impacts not just on the immediate illness but all subsequent treatment and contact with other HCPs regardless of whether it is related to the initial condition.
Basically, if you ever feel you are pressured to consent in ANY circumstances by a HCP, then your consent might not be valid, and you have a right to make a complaint to address why this situation arose and whether it was a matter of poor communication or an abuse of power.
The situations in which you can be deemed to lack capacity are rare, and your history or previous expressions of concern over consent are relevant and important in these rare instances.
Its also worth pointing out you can not be put into a situation where you are told that you must accept treatment from Dr X or you will not receive any treatment as this is effectively blackmail and you would be consenting under duress. The NHS would have to offer a reasonable alternative solution which you are happy to consent to.
I would stress here, that this is where it differs considerably to a patient who is merely racist. Its about what is considered reasonable according to the patient's individual circumstances and those should override those of a HCP if they are practising ethically and within the guidelines.
I hope that is clear and easy to understand. It needs to be repeated over and over and over again to drip, drip it through to women.
It is a minefield for HCP, but it is down to them to demonstrate they have done everything possible to obtain and respect your consent / refusal of it.
In the context of this particular thread, its noteworthy too.