Consent

Question 1

Why is consent a good thing?

Answer 1

• deontological justification

- consequentialist justification

Question 2

What are the four criteria for valid consent?

Answer 2

• patient must have capacity
• patient must Gove consent voluntarily
• patient must be informed
• consent must be continuing

Question 3

What form can consent take?

Answer 3

• written consent - (fertility treatment, good practice in surgery)
• assumed consent - seeking and complying with treatment
• verbel consent

Question 4

Explain “free to make decisions”

Answer 4

a mentally competent patient has a right to refuse consent to medical treatment for any reason - rational, irrational, or no reason - even if that reason leads to their death

Question 5

What are the two approaches to capacity?

Answer 5

• status
• function
  the law uses a combination

Question 6

Adult capacity? (Scotland)

Answer 6

When a person is ABLE to:

• understand information
• retain the information
• use or weigh the information
• communicate their decision
• hold decision consistently

Question 7

Adult incapacity? (Scotland)

Answer 7

When person is INCAPABLE of:
- acting 
- making decisions
communicating decisions
- understanding decisions
- retaining the memory of decisions

Question 8

Mental Capacity Act England?

Answer 8

• person assumed to have capacity unless established otherwise
• person not to be treated as if they lack capacity to make a decision unless all steps have been taken to help them in the decision making process
• person not to be treated as unable to make a decision, just because the decision is unwise
• decision made on behalf of a person who lacks capacity must be in that persons best interests

Question 9

Why might someone lack capacity?

Answer 9

impairment of, disturbance in the functioning of, the mind of brain
- can be permanent or temporary

Question 10

Define capacity?

Answer 10

sufficient understanding and memory to comprehend in a general way the situation in which one finds oneself and the nature, purpose, and consequence of any act or transaction into which one proposes to enter

Question 11

What makes assessing capacity difficult?

Answer 11

• not a once and for all judgement - things can change
• non-cooperation - patient not willing to be assessed for capacity
• just because decision is bizarre does not mean patient lacks capacity
• underlying conditions may cloud your judgement - may or may not affect patients capacity- assumptions
• communication problems

Question 12

Who can be proxy-decision makers?

Answer 12

• power of attorney (PA) - welfare attorney
• advanced directives/decisions (note on JW)
• best interests test (HCP, relatives, carers)

Question 13

What are the problems with proxies?

Answer 13

• proxy and patient do not always agree

- proxy decisions are normally subject to “best interests” - so not own decision

Question 14

The age of legal capacity? (Scotland)

Answer 14

• a person of or over the age of 16 years shall have legal capacity to enter into any transaction
• a person under 16 shall have legal capacity to consent on their own behalf to any procedure or treatment where, in the opinion of a qualified medical practitioner attending him, is capable of understanding the nature and possible consequences of the procedure or treatment

Question 15

What happens with consent for a child under 16?

Answer 15

• consent of one parent is enough

- if disagreement of parents then the court can authorise, overrule but not compel

Question 16

What is Gillik competence?

Answer 16

describe whether a child under the age of 16 can consent to medical treatment without parental permission or knowledge
- does the minor understand the treatment and its implications enough to give informed consent

Question 17

What do the Fraser Guidelines apply to?

Answer 17

• prescribing contraception to under 16s