11- Consent, capacity and advanced care planning Flashcards
what is consent
- ‘permission for something to happen or agreement to do something’*
- in medicine often involves a patient providing permission for a treatment or investigation
three types of consent
- Informed
- Expressed
- Implied
how can consent be provided
- Written consent- most legally binding
- Oral consent- less legally substantial
- ensure documented in notes
1. implied consent- least legally binding - may be misinterpreted
why is consent importnant
- patient has right to preserved their body integrity
- if consent not obtained- dr can be sued for battery
- promotes good dr patient relationship
refusal of consent
- competent adult has the right to refuse lifesaving treatment
- patient can withdraw consent at any time
valid consent
- patient must be fully informed
- patient must be competent to provide consent
- consent must be voluntary
informed consent
- nature of treatment/investigation
- why it is needed
- how the procedure will be performed
- riska dn benefits
- alternative treatments
- likely success
Capacity- competent consent
Mental Capacity Act 2007
- Patient must understand relevant info provided - could ask patient to repeat back info
- Retain information
- Weigh up pros and cons to make informed decision
- Communicate decision to doctor (talking, sign or writing)
special circumstances of consent
doctorss can provide treatment without consent when
- emergency situtation with an incompetent adult
- mentally ill patients
- children <16 yrs
Consent in minors
Young children and older children who are not Gillick competent cannot consent for themselves. In British law the patient’s biological mother can always provide consent. The childs father can consent if the parents are married (and the father is the biological father), or if the father is named on the birth certificate (irrespective of marital status). If parents are not married and the father is not named on the birth certificate then the father cannot consent.
Young children and older children who are not Gillick competent cannot consent for themselves.
- In British law the patient’s biological mother can always provide consent.
- The childs father can consent if the parents are married (and the father is the biological father), or if the father is named on the birth certificate (irrespective of marital status).
- If parents are not married and the father is not named on the birth certificate then the father cannot consent.
Gillick and fraser competence
- Gillick competency is often used in a wider context to help assess whether a child <16 has the maturity to make their own decisions and to understand the implications of those decisions.
- The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health.
Consent forms used in UK NHS
Principles used when a patient lacks capacity
- Make care of patient first concern
- Treat patients as individuals and respect their dignity
- Support patients to be involved
- Treat patients with respect and do not discriminate against them
- Use any advocates the person may have previously identified
- Decisions must take into consideration what the person would have wanted should they have had the capacity to make a decision
things to consider when a patients lacks capacity
- Is lack of capacity temporary or permanent?
- Which options would provide overall benefit?
- Which option is least restrictive of patient’s future choices?
- Has patient any previously expressed preferences (advanced decision/statement)?
- Have you considered the view of those close to the patient and whether they believe this is in the patient’s best interests?
- Any decision made must be in the best interests of the person
2 stage test for capacity (MCA 2005)
1) Does the person have an impairment/disturbance of their mind or brain?
→ temporary or permanent, as a result of illness or external factors (such as EtOH) or drug use)
2) Is this impairment/disturbance sufficient that the person is unable to make a specific decision when they to?
who to consult if a person lacks capacity
- Next of kin (NoK)
- Family/friends
- Persons involved in care
- IMCA (independent mental capacity advocate)
- If no representatives exist and decision can wait
- Decision long term placement
- Only advises, final decision with healthcare team
if person lacks capacity and no LPA/ valid advanced statement
best interest decision made
best interest decision principles
Encourage participation of the person
You should do whatever is reasonably possible to permit and encourage the person who lacks capacity to take part, or to improve their ability to take part in making the decision.
Identify all relevant circumstances
You should try to identify all of the things that the person who lacks capacity would take into account if they were making the decision for themselves.
Find out the person’s views
You should try to find out the views of the person who lacks capacity, including:
- Their past wishes and feelings about the matter to be decided;
- Their present wishes and feelings about the matter to be decided;
- Any beliefs or values that would be likely to influence the decision in question (for example religious, cultural, moral or political beliefs); and
- Any other factors that the person would be likely to consider if they were making the decision or acting for themselves.
remember that capacity is
- time specific
- e.g. if drunk
- decision specific
- patient may be able to consent to some things e.g. take para , but not others e.g. for operation
define lasting power of attorney
A lasting power of attorney (LPA) is a way of giving someone you trust, your attorney, the legal authority to make decisions on your behalf if you lose the mental capacity to do so in the future, or if you no longer want to make decisions for yourself.
There are two types of LPA:
- LPA for financial decisions
- LPA for health and care decisions.
LPA for health and care decisions
This covers health and care decisions and can only be used once you have lost mental capacity. An attorney can generally make decisions about things such as:
- where you should live
- your medical care
- what you should eat
- who you should have contact with
- what kind of social activities you should take part in.
You can also give special permission for your attorney to make decisions about life-saving treatment.
define public guardian
The role of the Public Guardian is to protect people who lack capacity from abuse. The Public Guardian, supported by the Office of the Public Guardian (OPG), helps protect people who lack capacity by: Setting up and managing a register of Lasting Powers of Attorney (LPA);
define deputies
You can apply to become someone’s deputy if they ‘lack mental capacity’. This means they cannot make a decision for themselves at the time it needs to be made. They may still be able to make decisions for themselves at certain times.
People may lack mental capacity because, for example:
- they’ve had a serious brain injury or illness
- they have dementia
- they have severe learning disabilities
As a deputy, you’ll be authorised by the Court of Protection to make decisions on their behalf.
define independent mental capacity advocate
IMCAs are a legal safeguard for people who lack the capacity to make specific important decisions: including making decisions about where they live and about serious medical treatment options. IMCAs are mainly instructed to represent people where there is no one independent of services, such as a family member or friend, who is able to represent the person.
