07-10-21 Consent Flashcards
Why is consent important in medicine?
Why is consent a good thing?
- Informed consent is a key principle of medical law – touching patients without their consent is unlawful (can be considered an assault, which is battery)
- Consent it a good thing because of deontological (good and bad according to clear set of rules) and consequentialist (action is good or bad depending on the outcome) justification.
What are the 4 criteria for valid consent?
- Patient must have capacity
- Patient must give consent voluntarily
- Patient must be informed
- Consent must be continuing
Describe the rights of a capacitous patient as regards refusal of, preference for and demanding of treatment
- A mentallyt competent patient has an absolute right to refuse consent to any medical treatment for any reason, rational, irrational, or no reason, even when that decision may lead to his or her own death.
- Patients can only reject treatment that is suggested, they cant demand treatment that has not been suggested by the doctor.
What 3 forms can consent take?
When might it be used?
Written consent
• Needed for fertility treatments and surgery
Assumed consent
• This is for when the patient seeks/complies with treatment e.g attending an appointment and rolling up sleeve for vaccine.
Verbal consent
What are the 5 criteria used in the adults with incapacity (Scotland) act 2000?
- A person can make decisions for themselves if they are able to:
- Understand the information
- Retain the information
- Use or weight the information
- Communicate their decision
- Hold decision consistently
What 4 things does the mental capacity act say about capacity?
- A person is assumed to have capacity unless its established otherwise
- A Person is not treated as if they lack capacity to make a decision unless all steps have been taken to help them in the decision-making process
- A person is not to be treated as unable to make a decision just because the decision is ‘unwise’
- A decision made on behalf of a person who lacks capacity must be in that person’s best interest.
What are the two approaches to capacity?
Why might someone not have capacity?
- Status and function are the 2 approaches to capacity.
* Someone may lack capacity to due impairment of the function of the brain (temporary or permanent)
What 5 factors make assessing capacity difficult?
- Its not a once and for all judgement (it can change)
- Non-cooperation
- If the decision is irrational or bizarre, it does not mean the patient lacks capacity
- Underlying conditions may cloud your judgement (a brain tumour that may or may not affect the patient’s capacity)
- Communication problems (deaf, blind, language barrier)
What are 3 ways decisions can be made on behalf of a patient who lacks capacity?
What are potential problems with these options?
- Proxies can be used, such as:
- Lasting power of attorney (LPA)
- Lasting directives
- Best interests test (relatives, carers)
- The proxy and patient may not agree
- The proxy decisions are normally subject to our best interests, so what happens to us may not be our own decision.
How is consent giving for children?
What can be the problem with this?
What is the age of consent for the UK?
- Consent of 1 parent is enough for most procedures.
- If there is disagreement, the court can authorise, overrule, not compel
- The age of consent in the UK IS 16 or over for people to make their own decisions regarding their medical treatment.
Where does Gillicks competence come from?
What is it an assessment of?
What criteria does it use?
- Gillicks competence comes from 1986: Landmark case, and involved Victoria Gillick and her children
- It is an assessment of whether advice centred around contraception should be given to under-16s without parental consent
- It utilises the Fraser Guidelines as criteria to assess this
What are the 5 criteria featured in Fraser guidelines?
- The person will understand the advice
- They can not be persuaded to inform their parents or allow you to inform their parents about them seeking contraceptive advice
- They are likely to continue having sexual intercourse with, or without, contraceptive treatment
- Unless they receive this contraceptive advice/treatment, their physical and/or mental healthy are likely to suffer
- Their best interests require you to give contraceptive advice/treatment without parental consent
What are some difficulties around informed and continuing consent in practise?
- How much information is enough (sufficiently informed?)
- Consent is a process (continuing) not an event
- Do patients understand what consent is all about?
What is important about voluntary consent?
• Patients must not be coerced into treatment (but pressure in and of itself, is not coercion) – beware of undue influence
