Block 3: Week 4 - Treatment in the Emergency Department

Question 1

What information is required for consent to be valid?

Answer 1

Capactiy

Information

Voluntariness

Question 2

What should be considered when getting consent?

Answer 2

Consent should be appropriate to the situation:

• Level of information needed/possible
• How/ whether to facilitate capacity (pain relief, environment, timing, support)

Question 3

What is the legal framework surrounding consent in a person who lacks capacity- who may give consent on their behalf?

Answer 3

Proxy consent possible (MCA):

• Lasting Power of Attorney (LPA)
• Court-appointed deputy- appointed when pt lacks capacity

Question 4

Treating without consent what are the three times you can do this?

Answer 4

1) Doctrine of Necessity (common law)

• Urgency → Life-threatening & may mean reduced time for ax capacity
• ONLY: Tx to save life/ prevent serious deterioration. Must be least restricitve of patient’s future choice

2) Patient lacks capacity → Best Interests (MCA)

• Consider:
  
  • a) Past, present wishes & feelings (in particular relavent written statements when had capacity)
  • b) Beliefs, values likely to influnce to his decision if had capcity
  • c) Other factors that they would consider

3) Patients can be detained under MHA- whether or not they have capacity
* Very specific conditions

Question 5

What is the Doctrine of Necessity?

What type of Tx does it allow?

Answer 5

Doctrine of Necessity(common law)

• Urgency → Life-threatening & may mean reduced time for ax capacity
• ONLY: Tx to save life/ prevent serious deterioration. Must be least restricitve of patient’s future choice

Question 6

What are the criteria for capacity- MCA?

Answer 6

a) Understand the information necessary to make decision
b) Retain the information long enough to make decsion
c) Weigh up the information
d) Communicate by any means their decision

Question 7

What are the specifics of Best intrests- MCA?

Answer 7

Consider:

a) Past, present wishes & feelings (in particular relavent written statements when had capacity)
b) Beliefs, values likely to influnce to his decision if had capcity
c) Other factors that they would consider

Question 8

What should Best Interests (MCA) not merely be made in the basis of?

Answer 8

a) Person’s age/ appearance
b) Condition of his/ aspect of his behaviour which might lead others to make unjustified assumption about what might be done in their best interests

Question 9

What is considered Restraint under MCA?

Answer 9

D restrains P if:

A) Uses/ threatens to use force to prevent P from acting which P resists

OR

b) Restricts P’s liberty of movement- whether or not P resists

Question 10

What are the conditions of restraint under MCA?

Answer 10

1) Reasonable belief that it is necessary to do the act in order to prevent harm to patient
2) Act is proportionate to:
a) Likelihood of P suffering harm
b) Seriousness of that harm

Question 11

Treatment of children in ED- who can give consent?

Answer 11

A) Competent Child

B) Parents

• Parental responsibility (Children Act 1989) is;
  
  • Mother
  • Father- if married to mother at time of child’s birth OR
    
    • Registered on birth certificate
    • Parental Responsibilty Agreement with mother
    • Various kinds of court order

Question 12

What are the other important issues in the ED?

Answer 12

1) Disclosure of information:

• Family
• Police
• Social services

2) Organ donation
3) Resource allocation