Consent

Question 1

What is consent to treatment?

Answer 1

A person must give permission before they receive any type of medical treatment, test, or examination which must be done on the basis of an explanation by a clinician with appropriate experience and expertise

Question 2

What are different expressions of consent?

Answer 2

Implied or verbal agreement for non invasive treatment ie blood pressure, ECG
Express consent for minor or routine investigaions ie IV access
Written consent for high risk procedures such as surgery

Question 3

What must the patient be told in informed consent?

Answer 3

Practicalities of procedure
Benefits/risk of procedure
Benefits/risk if procedure not done/treatment refused

Question 4

What are important factors of gaining consent?

Answer 4

Listen to patients and respect their views about their health
Discuss with patients their diagnosis, prognosis, and treatment
Share with patients the information they want or need in order to make decisions
Maximise patient opportunities and ability to make decisions for themselves - autonomy
Respect patient decisions

Question 5

What should be done if a patient requests a treatment that the doctor does not consider beneficial?

Answer 5

Explain reason for not thinking it beneficial to patient
Explain other available options
Include option of seeking second opinion

Question 6

What should be recorded about patient decisions?

Answer 6

Information discussed
Specific requests by the patient
Written, visual, or audio info given to patient
Details of decisions made

Question 7

When should patient decisions be reviewed?

Answer 7

Before beginning treatment
If significant time has passed since initial decision was made
There have been material changes in patient’s condition or in any aspect of proposed treatment

Question 8

What factors can temporarily affect capacity?

Answer 8

Pain
Fear
Confusion
Effects of medication/illicit drugs/alcohol

Question 9

What are general factors that can reduce capacity?

Answer 9

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

Question 10

What are the 5 principles of the AWI(S)A act?

Answer 10

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

Question 11

What is power of attorney?

Answer 11

Individuals - whilst they still have capacity - can grant someone they trust powers to act as their continuing financial and/or welfare attorney

Question 12

When does welfare power of attorney come into effect?

Answer 12

When the granter loses capacity

Question 13

How is treatment decided in those without a welfare power of attorney?

Answer 13

Healthcare professionals treating them can administer treatment if they believe it is in person’s best interests
Clinician’s must make reasonable steps to discuss with patient’s friends/family before making decisions
Case may be taken to court if clinicians and family can’t reach an agreement

Question 14

What should be done in case of intoxication by drugs/alcohol or is unconscious?

Answer 14

If possible wait until patient has sobered up/regained consciousness
In life threatening situation clinicians may act on behalf of patient to perform procedure in their best interest

Question 15

What can be done if there are communication difficulties?

Answer 15

Next of kin
Braille information leaflets/consent form
Sign language
Interpreter via telephone or in person

Question 16

At what age are people entitled to consent in their own treatment?

Answer 16

16 in Scotland

Question 17

When can children under 16 consent to their own treatment?

Answer 17

If they show Gillick competence

Question 18

What is involved in Gillick competence?

Answer 18

Child must have enough:
Intelligence
Competence
Understanding

Question 19

When can consent be overruled in a young person?

Answer 19

If young person refuses treatment which may result in death or severe permanent injury
Parents can consent for children in some cases

Question 20

What are the 5 Fraser guidelines for contraception in under 16s?

Answer 20

They have sufficient maturity and intelligence to understand nature and complications of treatment
They can’t be persuaded to tell parents or allow doctor to tell them
Very likely to continue intercourse with or without contraception
Physical or mental health is likely to suffer without treatment or advice
Advice or treatment is in young person’s best interest