Consent Flashcards
Is touching a patient without their consent assault?
Yes
Why is consent a good thing?
Recognising the patient’s rights
The result of getting a patient’s consent makes it clear to the Doctor
What are the four criteria for valid consent?
Patient must have capacity
Patient must give consent voluntarily
Patient must be informed
Consent must be continuing
What is capacity?
The patient’s ability to give consent
What did Butler Sloss LJ state in 1997?
“A mentally competent patient has an absolute right to refuse to consent to medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to his or her own death”
When is written consent necessary?
Fertility treatment
Good practice in surgery
What are the two forms of consent?
Written
Assumed
What are the two approaches to capacity?
Status
Function
What does the Adult with Incapacity Scotland Act 2000 state?
A person has capacity if;
They can understand the information
Retain the information
Use of weigh the information
Communicate their decision
Hold decision consistently
How is a person’s capacity assumed?
Assumed to have capacity unless its established otherwise
When can we say a patient doesn’t have a capacity?
When all steps to help them make a decision has occurred
What does the mental capacity act state?
A person is assumed to have capacity unless its established otherwise
A person is 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
A person is not to be treated as unable to make a decision, just because the decision is unwise
A decision made on behalf of a person who lack capacity must be in that person’s best interests
Why might someone lack capacity?
Impairment of, disturbance in the functioning of, the mind of brain
What can a patient’s brain function be classified by?
Permanent
Temporary
What makes assessing capacity difficult?
It’s not a once and for all judgement
Non-cooperation
Just because the decision is irrational or bizarre, does not mean patient lacks capacity
Underlying conditions may cloud your judgement
Communication problems
What happened in 2013 in Ninewells?
A deaf patient was left without a interpreter for 12 days
Who/what can be a proxy-decision maker for a patient who doesn’t have capacity?
Power of attorney
Advance directives
Best interests test- talk to people who know the patient
What are some problems with proxies?
Proxy and patient do not always agree
Proxy decisions are normally subject to “best interests”
When should a person be old enough to enter any transaction in Scotland?
16
What does section 2, paragraph 4 of the Age of Legal Capacity Act state?
A person under the age of 16 years shall have legal capacity to consent on his or her own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending him, he is capable of understanding the nature and possible consequences of the procedure or treatment
What does consent of a child require?
Consent from 1 parent
What happens if the parents disagree?
The court can authorise, overrule but can not compel treatment
What happened in the Victoria Gillick case in 1986 (England)?
Victoria Gillick was unhappy that Doctor’s prescribed her 14 year old daughter contraceptive pills
What did Jackson state in 2010?
Consent is no less effective when it is unwillingly or reluctantly give
What can a Doctor not do when a patient makes a decision?
Can not coerce
What was Lord Fraser’s conclusion in regard to Victoria Gillick’s case?
The doctor was right because;
The girl understood the advice
Patient confidentiality
She is likely to carry on having sexual intercourse with or without contraception
Unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer
