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.

This must be doneon the basis ofa full explanation by a clinician with appropriate experience and expertise (ie junior doctor cannot obtain consent from a patient for a surgical procedure that you as a junior doctor have not performed or understand the nuances/risks of the procedure)

Consent from a patient is needed regardless ofthe procedure.

Question 2

When might written consent be required?

Answer 2

For a surgical intervention that involves higher risk

Question 3

What is implied consent?

Answer 3

An assumption of permission that is inferred from actions on the part of the individual.

This can be accepted for things like taking a patient’s blood pressure or ECG

Question 4

Expressed consent is required for minor or routine investigations such as…

Answer 4

Taking blood

IV access

ABG

Question 5

Intimate examinations require what to make them appropriate?

Answer 5

A chaperone

Question 6

What is meant by Informed consent?

Answer 6

The patient/individual has been informed of the practicalities of the procedure including the benefits/risks of the procedure and the benefits/risks if they opt not to have the procedure done / refuse treatment.

Question 7

How does the doctor decide which investigations/treatments are in the best interests of the patient?

Answer 7

A doctor will use their specialist knowledge, experience and clinical judgement, alongside the patient’s views and understanding of their condition to identify best investigations or treatments for the patient.

A doctor can recommend a particular option but should not put pressure on the patient to comply

Question 8

What if a patient asks for a treatment that a doctor considers would not be of overall benefit to them?

Answer 8

The doctor does 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 9

Where should you record details about consent + conversations you’ve had with the patient throughout the decision making?

Answer 9

In the patient’s medical records or a consent form - record the key elements of your discussion ie what 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 10

When should you review a patient’s decision regarding treatments/procedures etc?

Answer 10

Before beginning treatment, you or a member of the healthcare team should 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:

• Significant time has passed since the initial decision was made
• There have been material changes in the patient’s condition, or in any aspect of the proposed

Question 11

A patient is said to have capacity if they can do what?

Answer 11

Understand, believe, retain and weigh the necessary information given to them

Question 12

What factors may temporarily affect a patient’s capacity to make a decision?

Answer 12

Fear
Pain
Confusion
Effects of medication/illicit drugs/alcohol

Question 13

What obstacles are there to capacity? (5)

Answer 13

Impaired intellectual/mental capacity

Intoxication - drugs or alcohol (voluntarily or involuntarily)

Unconsciousness - due to trauma or a medical condition

Communication difficulties - hearing impaired, mute, language

Age related issues - dementia

Question 14

The legislation regarding treatment and care of patients who lack capacity is different between Scotland and England.

What name is given to the legislation in each country?

Answer 14

England - Mental Capacity Act 2005

Scotland - Adults with Incapacity Act 2000

Question 15

Which decisions cannot be made on behalf of a person who lacks capacity? (2)

Answer 15

Consent to marriage or making a will

Question 16

What is a power of attorney?

Answer 16

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.

One or more persons can be appointed. A continuing (financial) power of attorney continues or commences (where specified) on the granter’s loss of capacity (granter may not be well enough to get to the bank).

A welfare power of attorney only comes into effect when the granter loses capacity.

All powers of attorney under the Act must be registered with the Public Guardian.

Question 17

If a person does not have the capacity to make a decision about their treatment and they do NOT have a lasting power of attorney what should healthcare professionals do?

Answer 17

Healthcare professionals treating them can administer treatment if they believe it’s in the person’s best interests.

Clinicians must take reasonable steps to discuss the situation with the person’s friends or relatives before making these decisions.

If an agreement cannot be reached between family and clinicians, the case may be taken to court.

Question 18

What if a patient is impaired by drugs/alcohol or unconsciousness?

Answer 18

If possible wait until the patient 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 19

How should doctors deal with communication difficulties with patients?

Answer 19

Next of kin

Braille info leaflets/consent form

Sign language

Interpreter via telephone or in person

Question 20

What is the definition of a child in Scotland?

Answer 20

In most situations, a child is someone who is under 18.

But 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 21

In Scotland, can a 16 year old consent to their own treatment?

Answer 21

Yes and this can only be overruled in exceptional circumstances

Question 22

In Scotland, can a child under the age of 16 consent to their own treatment?

Answer 22

Yes if they’re believed tohave enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment- Gillick competent (this is enshrined in law in Scotland but not England but is used in both countries)

Question 23

Which court can overrule a young person’s refusal for treatment if it may lead to their death or a severe permanent injury?

Answer 23

Court of Protection

Question 24

If a young person has refused treatment can the parents consent for them?

Answer 24

Yes but it’s usually best to go through the courts in this situation

Question 25

What is a voluntary decision?

Answer 25

The decision to either consent or not to consent to treatment must be made by the person, and must not be influenced by pressure from medical staff, friends or family

Question 26

How did the decision of Montgomery change the law on consent?

Answer 26

Now risk is determined by what the reasonable patient in those circumstances would expect to be told not what the ordinarily competent doctor would have told them.

The law is now more patient centered and in tune with realistic and modern medicine