Consent Flashcards
What is consent?
Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination
Who must gain consent?
Clinician with appropriate experience and expertise who can give an explanation
What are different expressions of consent?
- Implied or verbal agreement for non-invasive treatments e.g. BP, ECG
- Express consent for minor or routine investigations e.g. IV access, ABG
- Written consent for procedures of high risk e.g. surgery
- Examination of intimate zones with lack of adequate consist renders practitioner liable for indecent assault
What happens if there is examination or treatment without appropriate consent?
Can be liable of indecent assault or common assault
What is informed consent?
Patient should be informed of the practicalities of the procedure, benefits/risks of procedure and benefits/risks if procedure not done or refusal of treatment
What happens if patients asks for treatment that doctor considers would not be of overall benefit to them?
Do not have to provide the treatment
Should explain their reasons to the patient, explain other options available, including option to seek second opinion
What should recording decisions involve?
Use patients medical records or a consent form to record key elements of your discussion with the patient
Should include info you discussed, any specific requests by the patient, any written, visual or audio info given to patient and details of any decision made
When should review decisions with patient?
Before beginning treatment, should check patient still wants to go ahead and respond to any new or repeated concerns or questions
When is reviewing decisions important with patients?
If significant time has passed since the initial decision was made
There have been material changes in patient’s condition or any aspect of the proposed
What does capacity mean for consent?
Patients with capacity can make their own decisions to refuse treatment, even if these decisions appear irrational to doctor or may place patients health or life at risk
What is capacity?
Patient can understand, believe, retain and weight the necessary information given to them to make a decision
What are examples of obstacles to capacity?
Impaired intellectual/mental capacity Intoxication Unconsciousness Communication issues: hearing, mute, language Age
What act governs making decisions about treatment and care for patients who lack capacity in Scotland?
Adults with Incapacity (Scotland) Act 2000
For the purposes of the Adults with Incapacity Act 2000, what does incapable mean?
Incapable of:
- acting on decisions
- making decisions or: communicating decisions, understanding decisions, retaining the memory of decisions
- in relation to mental disorder or inability communicate because of physical disability
What are the 5 principles of the Adults with Incapacity Act?
- Any action or decision taken must benefit the person
- Least restrictive option
- Take account wishes of person
- Consultation with relevant others
- Encourage person to use existing skills and develop new skills
What decisions can never be made on behalf of person who lacks capacity?
Consent to marriage
Making a will
What can a proxy not do on behalf of a person without capacity?
Cannot place person in mental hospital against his/her will
Consent to certain treatments on his/her behalf
What is power of attorney?
A means by which individuals, whilst they still have capacity, can grant someone they trust powers to act as their continuing (financial) and/or welfare attorney
When does a persons power of attorney commence?
When granter loses capacity
Who must all powers of attorney under Adults Without Capacity act be registered with?
The Public Guardian
What happens if person does not have capacity to make decision about treatment and have not appointed power of attorney?
Healthcare professionals can administer treatment if they believe it’s in the person’s best interests
Discussion with friends/relatives
If disagreement - case may be taken to court
What happens if need consent for treatment and impairment with drugs/alcohol/unconsciousness?
If poss - wait until patient able to consent
If life-threatening - act on behalf of patient to perform procedure in their best interest
In Scotland, what is the definition of a child?
Under 18
However, Children’s hearings/child protections orders, child under 16
At what age are people entitled to consent to own treatment?
16+
When can children under age 16 consent to own treatment?
If believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment = Gillick competence
What is Gillick competence?
If child under 16yo believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment
When can consent be overruled in young person?
If young person refuses treatment, which might lead to their death of severe permanent injury - decisions can be overruled by Court of Protection
What is the Court of Protection?
Legal body that oversees operation of Mental Capacity Act (2005)
