Consent

Question 1

What should a patient/individual be informed of in order to give informed consent?

Answer 1

Practicalities of the procedure
Benefits/risks of the procedure
Benefits/risks if procedure not done/refusal of treatment

Question 2

What should a doctor do if the patient asks for a treatment that the doctor believes would not be of overall benefit to them?

Answer 2

They do not have to provide the treatment, 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 3

Is consent dependent upon capacity?

Answer 3

Yes, directly dependent

Question 4

What does it mean to have capacity?

Answer 4

To be able to understand, believe, retain and weigh the necessary information to make an informed decision and give consent

Question 5

What factors can temporarily affect an individual’s capacity or cause it to fluctuate?

Answer 5

Pain
Fear
Confusion
Effects of medication/illicit drugs/alcohol

Question 6

What are some of the obstacles to capacity?

Answer 6

Impaired intellectual/mental capacity
Intoxication (drugs or alcohol)
Unconsciousness
Communication difficulties - hearing impaired, mute language
Age

Question 7

Which Act governs making decisions about treatment and care for patients who lack capacity in England and Wales?

Answer 7

Mental Capacity Act 2005

Question 8

Which Act governs making decisions about treatment and care for patients who lack capacity in Scotland?

Answer 8

Adults with Incapacity (Scotland) Act 2000

Question 9

Which Act governs making decisions about treatment and care for patients who lack capacity in Northern Ireland?

Answer 9

In Northern Ireland, there is currently no relevant primary legislation, and decision making for patients without capacity is governed by the common law.

Question 10

For the purposes of the Act, “incapable” means incapable of what?

Answer 10

Acting on decisions, or
Making decisions, or
- communicating decisions, or
- understanding decisions, or
- retaining the memory of decisions
In relation to any particular matter due to mental disorder or inability to communicate because of physical disability

Question 11

What are the five principles of the Act?

Answer 11

1. Any action or decision taken must benefit the person
2. Least restrictive option
3. Take account of the wishes of the person
4. Consultation with relevant others
5. Encourage the person to use existing skills and develop new skills

Question 12

What is Power of Attorney?

Answer 12

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 13

What should be done in the case of impairment by drugs/alcohol or unconsciousness?

Answer 13

If possible wait until the person has sobered up/regained consciousness before commencing treatment.
In a life threatening situation, healthcare professionals may act on the behalf of the patient to perform a procedure in their best interest.

Question 14

What should be done in the case of impairment by communication difficulties?

Answer 14

Make use of

• next of kin
• braille information leaflets/consent form
• sign language
• interpreter via telephone or in person

Question 15

What is the definition of a child in England, Northern Ireland and Wales?

Answer 15

Someone who has not yet reached their 18th birthday

Question 16

How does the definition of a child in Scotland differ to that in England, Northern Ireland and Wales?

Answer 16

In England, Northern Ireland and Wales, a child is someone who has not yet reached their 18th birthday. In Scotland, in some contexts (e.g. Children’s Hearings and Child Protection Orders) a child is defined as a person under 16 years of age.

Question 17

At what age can someone consent to their own treatment?

Answer 17

Anyone aged 16 or over can consent to their own treatment, as can those under 16 if deemed Gillick competent.

Question 18

Gillick v West Norfolk, 1984

Answer 18

“… whether or not a child is capable of giving the necessary consent will depend on the child’s maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent”

Question 19

What are the Fraser guidelines?

Answer 19

The guidelines set out by Lord Fraser in his judgement of the Gillick case in the House of Lords (1985), which apply specifically to contraceptive advice.

Question 20

When can consent be overruled in the young person?

Answer 20

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).
The parents of a young person who has refused treatment may consent for them, but it’s usually thought best to go through the courts in this situation.