relatives and thereafter come to a reasoned conclusion. It is not a decision to be taken under the duress of extreme pain. [25] Dr Kimberg testified that in reaching informed consent certain factors should be taken into account: (a) understanding the information relevant to the decision and being able to retain and assimilate that information; (b) being able to weigh that information as part of the process of making that decision; (c) being able to properly communicate that decision; (d) being aware of the short and long term possible repercussions of the decisions; (e) being aware of and able to evaluate the alternative options available, if any, and after having been duly informed of such alternatives; (f) not being subject to undue influence by the situation, environment and coercion by medical personnel (commonly referred to as medical paternalism) and/or other parties; and 13 (g) being advised of the ability to withhold consent, even if it might not be in her best interest to do so and the need to respect that decision. [26] In Foundational Principles of South African Medical Law supra the authors with reference to van Oosten LLD Thesis 458 stated that the patient’s right to informed consent is not absolute and that the needs and contingencies of medical practice sometimes, depending on the circumstances, place restrictions on the duty to disclose information. One of such restrictions is where the patient is already in possession of the requisite information. [27] The onus of establishing the defence of volenti non fit iniuria rests on the defendant. (See Santam Insurance Co. Ltd v Vorster 1973 (4) SA 764 (A) at 779 A – B). In the law of delict the onus to prove the existence of a ground of justification (in casu, volenti non fit iniuria) rests on the defendant. (See Mabaso v Felix 1981 (3) SA 865 (A); Ntamo v Minister of Safety and Security 2001 (1) SA 830 (TK) at 833 A; Ferreira v Ntshingila 1990 (4) SA 271 (A) at 273 A). [28] Whether or not informed consent was present is a factual issue and not a legal one. [29] Dr Kimberg testified that it is important to record the fact that alternative contraception methods have been discussed especially in a hospital situation because a patient may be seen by different doctors at different times, by different nurses and one does not have the advantage of getting to know the patients and their circumstances. In these instances the patient would be responsible to take the decision herself and needs to be fully informed as to what her options are. 14