Capacity and Consent

Question 1

What is Consent

Answer 1

Voluntary and continuing permission of the patient to receive a particular treatment

Question 2

If the patient is unconscious can you gain consent

Answer 2

In an emergency, where consent cannot be obtained you may provide medical treatment to anyone who needs it, but treatment must be limited to what is necessary to save life or limb.
It is not age specific

Question 3

State the two types of consent

Answer 3

Implied - Giving your arm over to have your BP taken

Expressed - Oral or written consent i.e. when your pt signs to stay at home or notes to be passed onto the GP

Question 4

Expand on the fact that consent must be voluntary

Answer 4

The decision to consent or not to consent must be voluntary and must be the patients, and must not be the result of coercion by medical staff, friends or family.

Question 5

What makes consent valid

Answer 5

• Volintary
• Informed
• Capacity

Question 6

What would you ask/tell the a patient before starting a treatment on them

Answer 6

• Explain the procedure
• Installs confidence in you and the patient
• Why your doing it
• Risks v Benefits

Question 7

What is the legislation for Capacity

Answer 7

• Mental Capacity Act 2005 used to Mental Capacity Act 1983

Question 8

Do not assume someone lacks capacity when

Answer 8

• You can not assume that someone lacks capacity because of - how old they look
  - how they look
  - how they act

Question 9

What age does someone have legal capacity

Answer 9

16

Question 10

What pneumonic can be used to assess capacity

Answer 10

U- Use
R- Retain
U- Understand
C- Communicate

Question 11

Name the five key principles of Mental Capacity Act 2005

Answer 11

1. Capacity is assumed until proven otherwise
2. All practicable steps must be taken until a person is deemed to not have capacity
3. A unsafe or unwise decision does not mean that the patient lacks capacity i.e. suicide
4. Where a decision is made on behalf of someone it must be in their best interests
5. Any decision made or action taken must be the least restrictive

Question 12

Name the two tests for capacity

Answer 12

Cognitive assessment

Functional assessment

Question 13

What is a cognitive assessment

Answer 13

Ask if,

• The person orientated to time, place or person
• Is the person able to follow simple instructions
• Is the person able to identify/locate familiar objects

Question 14

What is a functional assessment

Answer 14

URUC

Question 15

Capacity in children aged 16-18

Answer 15

• Can give consent for their own treatment

- Cannot refuse treatment

Question 16

Can children under the age of 16 have capacity

Answer 16

• If they have sufficient understanding and maturity to enable them to understand fully what is proposed, then yes they can have capacity

Question 17

What is the Gallic and Frazer test

Answer 17

A test of maturity, understanding of advise given to them to make there own decisions

Question 18

A person is defined as using restraint if

Answer 18

• They use force or threaten to use force to make someone do something that they are resisting
• Restrict a persons freedom of movement

Question 19

What are the two recommendations that need to be followed when you restrain someone who lacks capacity

Answer 19

1. The person taking action must believe that restraint is needed to stop someone who lacks capacity from harming themselves
2. Must be a proportionate response to the likelihood of them causing harm, the amount/type of restraint used

Question 20

What are the 4 types of restraint

Answer 20

Physical - Held by one or more people
Mechanical - Devices
Chemical - Sedation
Psychological - Objects taken away

Restraint is a criminal offence if there is no justification for its use

Question 21

Define what a Advanced directive or DNR or Living Will is

Answer 21

• Applies to over 18 who possess capacity at the time of the directive
• Only applies to refusals of treatment not requests for treatment
• Are specific to the advanced decisions which need to be made
• Decision can be cancelled at any time

Question 22

Decisions regarding DNR must be

Answer 22

• Valid and applicable in writing
• Signed and witnessed
• Clearly state that the decision applies even if life is at risk
• If a decision is valid then a health care professional must comply with the decision

Question 23

What does LPA stand for

Answer 23

Lasting power of attorney

Question 24

Which is of higher power LPA or DNR

Answer 24

A LPA made after the DNR will make the DNR invalid if the LPA gives the attorney authority to make decisions about the same treatment