Consent

Question 1

What is consent?

Answer 1

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

Question 2

What form of consent be expressed?

Answer 2

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

Question 3

When there is examination of an intimate zone what is required?

Answer 3

1) Inform patient
2) Gain adequate consent
3) Document this
4) Enquire about gender specification
5) Presence of a chaperone

Question 4

Without consent prior to examination or treatment what can occur?

Answer 4

Constituted an invasion of privacy which could be deemed common assault

Question 5

Examination of intimate zones without an adequate consent could lead to what?

Answer 5

Th practitioner being liable of indecent assault

Question 6

What is informed consent?

Answer 6

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.

Question 7

How is consent obtained?

Answer 7

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

Question 8

When obtaining consent what should a doctor not do?

Answer 8

They must not put pressure on the patient to accept their advice - no coercion.

Question 9

If the patient asks for a treatment that the doctor considers would not be of overall benefit to them what should the doctor do?

Answer 9

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.

Question 10

What should be done after gaining consent?

Answer 10

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.

Question 11

Before beginning a treatment/procedure what should be done?

Answer 11

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.

Question 12

When is it particularly important to review consent?

Answer 12

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.

Question 13

What is consent directly dependent on?

Answer 13

Consent is directly dependent upon capacity.

Question 14

What is capacity?

Answer 14

Those who can understand, believe, retain and weigh the necessary information required to give consent to a treatment, procedure or examination

Question 15

What can temporary reduce capacity to make decisions?

Answer 15

• Pain
• Fear
• Confusion
• Effects of medication
• Illicit substances
• Alcohol

Therefore assessment of capacity must be time and decision-specific

Question 16

In terms of consent and treatment what is the right of someone with full capacity?

Answer 16

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

Question 17

What are the obstacles in determining capacity?

Answer 17

• Impaired intellectual/mental capacity
• Intoxication
• Unconsciousness
• Communication difficulties
• Language
• Age

Question 18

What is the Adults with Incapacity (Scotland) Act 2000?

Answer 18

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.

Question 19

What is the Mental Capacity Act, 2005 (England and Wales)?

Answer 19

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.

Question 20

What legislation is in place for people in Northern Ireland who lack capacity?

Answer 20

Currently there is no primary legislation and decision-making for patients without capacity is governed by the common law

Question 21

In terms of capacity what does incapable mean?

Answer 21

Incapable of:
- acting on decisions; or

• making decisions; or
  communicating decisions; or
• understanding decisions; or
  retaining the memory of decisions.

Question 22

What are the five principles of the Adults with Incapacity (Scotland) Act, 2000?

Answer 22

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

Question 23

What is a Power of Attorney?

Answer 23

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.

Question 24

When does a welfare power of attorney come into effect?

Answer 24

In the even the granter (Of power of attorney) loses capacity

Question 25

When does a financial power of attorney come into effect?

Answer 25

Continues or commences where specified on the granter’s loss of capacity

Question 26

Who are power of attorneys registered with?

Answer 26

The Public Guardian

Question 27

If an individual has lost capacity but has not appointed a lasting power of attorney what should occur in terms of treatment?

Answer 27

A healthcare professional can administer treatment if they believe it is in the person’s best interest

Question 28

If there is no power of attorney and someone has lost capacity before treatment is undertaken what should occur?

Answer 28

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

Question 29

If impairment has occurred by drugs of alcohol what should occur in terms of treatment?

Answer 29

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

Question 30

How can you overcome difficulties in communication in terms of consent?

Answer 30

• Next of kin
• Braille information leaflets/consent forms
• Sign language
• Interpreter (Via phone or in person)

Question 31

How old is someone when deemed a child?

Answer 31

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.

Question 32

How old must someone be to consent their own treatment?

Answer 32

Over the age of 16. This can only be overruled in exceptional circumstances (16-17yrs)

Question 33

What is Gillick competent?

Answer 33

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

Question 34

What are the Fraser guidelines?

Answer 34

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.

Question 35

When can a young person’s (16-17ys) consent be overruled?

Answer 35

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

Question 36

What are the three most important things for consent to be valid?

Answer 36

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