Consent Flashcards
What is consent?
Consent to treatment means a person must give permissionbefore they receive any type of medical treatment, testor examination.
It is needed regardless of the procedure
What form of consent be expressed?
1) Implied or verbal agreement for non invasive treatments e.g. BP, ECG…
2) Expressed consent for minor or routine investigations e.g. IV access, ABG…
3) Written consent for procedures that involve higher risk e.g. surgical intervention
When there is examination of an intimate zone what is required?
1) Inform patient
2) Gain adequate consent
3) Document this
4) Enquire about gender specification
5) Presence of a chaperone
Without consent prior to examination or treatment what can occur?
Constituted an invasion of privacy which could be deemed common assault
Examination of intimate zones without an adequate consent could lead to what?
Th practitioner being liable of indecent assault
What is informed consent?
Any consent obtained should be informed.
The patient/individual should be informed of the practicalities of procedure, benefits/risks of procedure and benefits/risks if procedure not done or refusal of treatment.
How is consent obtained?
Medical decisions should be discussed and made as a partnership with your patients to ensure good care.
In so doing, you must:
- Listen to patients and respect their views about their health
- Discuss with patients their diagnosis, prognosis, treatment
- Share with patients the information they want or need in order to make decisions
- Maximise patients’ opportunities, and their ability, to make decisions for themselves- autonomy
- Respect patients’ decisions
When obtaining consent what should a doctor not do?
They must not put pressure on the patient to accept their advice - no coercion.
If the patient asks for a treatment that the doctor considers would not be of overall benefit to them what should the doctor do?
1) They do not have to provide the treatment.
2) However, they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.
What should be done after gaining consent?
Record decisions:
You must use the patient’s medical records or a consent form to record the key elements of your discussion with the patient. This should include the information you discussed, any specific requests by the patient, any written, visual or audio information given to the patient, and details of any decisions that were made.
Before beginning a treatment/procedure what should be done?
Reviewing decisions/consent:
- Check that the patient still wants to go ahead and respond to any new or repeated concerns or questions they raise.
This is particularly important if:
1) Significant time has passed since the initial decision was made.
2) There have been material changes in the patient’s condition, or in any aspect of the proposed.
When is it particularly important to review consent?
This is particularly important if:
1) Significant time has passed since the initial decision was made.
2) There have been material changes in the patient’s condition, or in any aspect of the proposed.
What is consent directly dependent on?
Consent is directly dependent upon capacity.
What is capacity?
Those who can understand, believe, retain and weigh the necessary information required to give consent to a treatment, procedure or examination
What can temporary reduce capacity to make decisions?
- Pain
- Fear
- Confusion
- Effects of medication
- Illicit substances
- Alcohol
Therefore assessment of capacity must be time and decision-specific
In terms of consent and treatment what is the right of someone with full capacity?
They have the right to refuse a treatment regardless of how irrational it may appear or the negative effects refusal will have of the patients health/life
What are the obstacles in determining capacity?
- Impaired intellectual/mental capacity
- Intoxication
- Unconsciousness
- Communication difficulties
- Language
- Age
What is the Adults with Incapacity (Scotland) Act 2000?
Legislation that sets out criteria and procedures to be followed in making decisions when patients lack capacity to make these decisions for themselves. It also grants legal authority to certain people to make decisions on behalf of patients who lack capacity.
What is the Mental Capacity Act, 2005 (England and Wales)?
Legislation that sets out criteria and procedures to be followed in making decisions when patients lack capacity to make these decisions for themselves. It also grants legal authority to certain people to make decisions on behalf of patients who lack capacity.
What legislation is in place for people in Northern Ireland who lack capacity?
Currently there is no primary legislation and decision-making for patients without capacity is governed by the common law
In terms of capacity what does incapable mean?
Incapable of:
- acting on decisions; or
- making decisions; or
communicating decisions; or - understanding decisions; or
retaining the memory of decisions.
What are the five principles of the Adults with Incapacity (Scotland) Act, 2000?
Principle 1 – any action or decision taken must benefit the person
Principle 2 - least restrictive option
Principle 3 - take account of the wishes of the person
Principle 4 - consultation with relevant others
Principle 5 - encourage the person to use existing skills and develop new skills
What is a Power of Attorney?
This is a means by which individuals, whilst they have capacity, can grant someone they trust powers to act as their continuing (financial) and/or welfare attorney.
When does a welfare power of attorney come into effect?
In the even the granter (Of power of attorney) loses capacity
When does a financial power of attorney come into effect?
Continues or commences where specified on the granter’s loss of capacity
Who are power of attorneys registered with?
The Public Guardian
If an individual has lost capacity but has not appointed a lasting power of attorney what should occur in terms of treatment?
A healthcare professional can administer treatment if they believe it is in the person’s best interest
If there is no power of attorney and someone has lost capacity before treatment is undertaken what should occur?
Clinicians should take reasonable steps to discuss the situation with the patient’s friends/family before making decisions.
If an agreement cannot be made between the family and clinicians the case may be taken to court
If impairment has occurred by drugs of alcohol what should occur in terms of treatment?
1) If possible what until the person is sober/regained consciousness
2) If it is a life-threatening situation the healthcare professional may act on the behalf of the patent to perform a procedure that is in their best interest
How can you overcome difficulties in communication in terms of consent?
- Next of kin
- Braille information leaflets/consent forms
- Sign language
- Interpreter (Via phone or in person)
How old is someone when deemed a child?
Below the age of 18
However in some contexts, for example Children’s Hearings and child protection orders, a child is defined as a person under 16 years of age.
How old must someone be to consent their own treatment?
Over the age of 16. This can only be overruled in exceptional circumstances (16-17yrs)
What is Gillick competent?
It is when a child under the age of 16 can consent to their own treatment if they’re deemed to have enough intelligence and competence and understanding to fully appreciate what is involved in their treatment
What are the Fraser guidelines?
A 1985 judgement by the House of Lords on a legal case which looked specifically at whether doctors should be able to give contraceptive advice or treatment to under 16-year-old girls without parental consent.
The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the Gillick case in the House of Lords (1985), which apply specifically to contraceptive advice.
When can a young person’s (16-17ys) consent be overruled?
If a young person refuses treatment, which may lead to their death or a severe permanent injury, their decision can be overruled by the Court of Protection -the legal body that oversees the operation of the Mental Capacity Act (2005).
Parent of a young person can consent for them although it will often still go through the courts
What are the three most important things for consent to be valid?
1) Voluntary - Must be by the patient and no influence/pressured from medical staff, friends or family
2) Informed - The patient must be given all the information about the treatment involved
3) Capacity - Understand, retain and believe the information given t them and can use it to make an informed decision
