7: Capacity and consent Flashcards
What does a patient need to be able to do to give their consent for an intervention?
Understand the intervention
Understand its pros and cons
Communicate their decision
Be able to retain the information
What stops a patient from being able to give informed consent for an intervention?
Lack of information
Cognitive impairment - inability to understand, weight up or retain information
Communication problems
Coercion
Does capacity for one decision apply to all other decisions a patient could make?
No
Assess capacity on a decision-by-decision basis
Who is an adult according to the
a) Adults with Incapacity Act
b) Mental Health Act?
a) 16+
b) 18+
What is the Adults with Incapacity Act FOR?
Treating physical illness in adults with mental disorders AND/OR inability to communicate
Can capacity be regained?
Yes
In acute, transient mental disorders like delirium
What does a patient need to know and repeat back to you to qualify as being informed about a decision?
What the intervention is, how it works and why it is being proposed
Benefits/risks
Consequences of not getting it
A patient should be assumed to (have capacity / not have capacity) until proven otherwise.
have capacity
What allows you to deal with medical emergencies regardless of the patient’s capacity (unless there’s an advance directive, DNR etc)?
Common law
What five principles must you keep in mind when using the Adults with Incapacity Act?
1. Intervention must benefit the patient
2. Benefit must not be achievable without the intervention
3. Patient’s wishes (past & present) must be considered
4. Other relevant people (e.g family) should be consulted
5. Patient should be encouraged to use what’s left of their capacity
If someone without capacity needs to receive an intervention, who should be consulted?
Patient (ask them anyway, they might have residual capactiy)
Decision-making proxies (power of attorney guardianship)
What decision-making proxy is appointed for patients who haven’t arranged someone to have power of attorney over them?
Guardianship
long process, bit of a headache
What is a Section 47 certificate?
Form you can fill out to authorise treatment in an incapable patient with no power of attorney or guardian
What should you do if you speak to a patient and, in your opinion, they don’t have capacity to consent to a treatment?
Document that
then fill out a section 47 form (assuming they have no decision-making proxies)
The AWIA allows you to treat (physical / mental) disorders in which two groups of patients?
physical disorders
in those with MENTAL DISORDERS or INABILITY TO COMMUNICATE
The MHA allows you to treat (physical / mental) disorders.
mental disorders
As opposed to AWIA, which is for physical disorders in patients with mental disorders or inability to communicate
What is covert medication?
Medication administered without the patient’s knowledge e.g tablets ground into food
Are you allowed to give covert medication to a patient?
Yes
If you can justify it under AWIA
Which detention form can be filled out by any FY2+ doctor with the consent of a Mental Health Officer?
Emergency detention
How long does an emergency detention last?
Can it be appealed?
72h
No appeal
How long does a short term detention order last?
Who authorises it?
Can it be appealed?
28 days
ST6+ psychiatrist + MHO
Yes
How long does a compulsory treatment order last?
Who authorises it?
6 months
Tribunal
Can you treat illness under an emergency detention order?
No
Requires a short term detention order
What is an advance statement under the MHA?
Document written by the patient stating that they would want to be admitted and treated if they became unwell
Emergency detention is advised under what circumstances?
Patient is mentally ill and needs to be assessed
They pose a risk to themselves or others
There’s no time to file for a short term detention
mind they can’t be treated
