Consent

Question 1

What is bodily integrity?

Answer 1

A law that states that if you touch someone without their consent you commit battery.

Question 2

What is professional competence?

Answer 2

A law that states if you obtain consent only because the patient does not know all the information about the side-effects and risks of the treatment, you commit negligence.

Question 3

For consent to be valid, what must be true of the information given to the patient about the treatment?

Answer 3

1 - Must be sufficient (including side effects and alternatives).

2 - Must be communicated effectively.

3 - A balance must be struck; misjudged balance impacts on voluntariness.

Question 4

Define voluntariness.

Answer 4

A choice being made of a person’s free will, as opposed to being made as the result of coercion.

Question 5

Which 4 principles must be addressed in order for consent to be valid?

Answer 5

1 - Information.

2 - Competence.

3 - Voluntariness.

4 - Decision.

Question 6

For consent to be valid, what must be true of the competence of the patient?

Answer 6

• The patient must be able to understand information (assessed at an individual level).
• However, related to the complexity and consequences of the decision.

Question 7

What is an advanced healthcare directive?

Answer 7

A legal document in which a person specifies which actions should be taken for their health if they lose their capacity to consent.

Question 8

What is a healthcare proxy?

Answer 8

A document with which a patient appoints an agent to legally make healthcare decisions on behalf of the patient when the patient loses capacity to consent.

Question 9

What is the consenting age for children in the UK?

What happens if a patient is under the consenting age?

Answer 9

• 16.

- If lower, competence has to be assessed on an individual basis.

Question 10

List 4 exceptions to consent.

Answer 10

1 - Emergency treatment to save life but incapacitated.

2 - Severe mental incapacity.

3 - Public health requirements (e.g. TB).

4 - Severely ill and living in unhygienic conditions.

Question 11

Describe the 2015 Montgomery v Lanarkshire Health Board case.

Answer 11

Montgomery sought damages against Dr McLellan who was responsible for her care during pregnancy and labour as her son was born with cerebral palsy.

Question 12

Give an example of when information must not necessarily be disclosed to a patient.

Answer 12

• If the disclosure of the information would be seriously detrimental to the patient’s health.
• Known as the therapeutic exception / privilege.

Question 13

What is a material risk?

Answer 13

• A risk is material if a reasonable person in the patient’s position would be likely to attach significance to it, or if the doctor is aware that their patient would be likely to attach significance to it.
• A doctor has a duty to ensure that the patient is aware of any material risk and of reasonable alternatives.

Question 14

Which relatives of a child have automatic parental responsibility?

Answer 14

• The mother.
• The father if he was married to the mother at the time of conception or birth. The father maintains responsibility if the parents divorce.
• Surrogate mothers, until the intended parents adopt the child.

Question 15

What is a voluntary order?

Answer 15

A legal document that means that parents retain responsibility over a child when they enter care.

Question 16

What is a care order?

Answer 16

A legal document that means that responsibility over a child is shared between the parents and the child’s social care team.

Question 17

What is an emergency protection order?

Answer 17

A legal document that means that responsibility over a child is taken over by the child’s social care team.

Question 18

With <16 year old children that are also parents, who has responsibility over the baby?

Answer 18

The <16 year old is expected to be competent (if there are concerns then social services are already usually involved), so is usually responsible.

Question 19

What is a residency order?

Answer 19

A court order settling the arrangements as to the person with whom a child is to live.

Question 20

How many of the parents with parental responsibility are required to give consent?

Answer 20

Only one, except in non-therapeutic circumcision.

Question 21

What must be done when there is disagreement between two parents with parental responsibility?

Answer 21

• With non-urgent care, clinicians should aim for consensus.

- With urgent care, one parent with parental responsibility is sufficient / best interests should be considered.

Question 22

What is Gillick competence?

Answer 22

A child under the age of 16 has the legal competence to consent to medical examination or treatment if they have sufficient maturity and intelligence to understand the nature and implications of that treatment.

Question 23

Summarise the Fraser guidelines concerning contraception in 5 bullet points.

Answer 23

• The doctor should not persuade the young person to inform their parents.
• The doctor should not inform the parents that their child is seeking contraceptive advice.
• The young person is likely to begin or continue having intercourse with or without contraception.
• Unless the young person receives contraception, their mental / physical health are likely to suffer.
• The young person’s best interests require the doctor to give contraception with or without parental consent.

Question 24

What is the difference between Gillick and Fraser competency?

Answer 24

Gillick competency refers to all medical care involving children whereas Fraser competency refers to contraception.

Question 25

If a young person is not able to consent, and nobody with parental responsibility is present, what guidelines should be followed?

Answer 25

• Doctors have a duty to act in the patient’s best interests.
• Doctors should only perform emergency treatment (required to save life or prevent serious harm).

Question 26

Are 16 and 17 year olds that are not deemed competent (e.g. learning difficulty) able to consent?

Answer 26

Yes, however people with parental responsibility can consent for them up to the age of 18.

Question 27

Do young people (0-15) have a right to refuse treatment?

Answer 27

• Yes (if they are Gillick competent), but not if it would put their health in serious jeopardy.
• Consent from a person with parental responsibility can override this refusal.

Question 28

Can 16 and 17 year olds refuse treatment?

Answer 28

• Yes (if they are Gillick competent).

- Consent from a person with parental responsibility can override this refusal ONLY in exceptional circumstances.