Consent and Capacity Flashcards
What are the 3 types of consent
Informed
Expressed
Implied
What consent forms are used in the NHS
Consent form 1
- For competent adults who can consent for themselves for procedures where consciousness may be impaired (e.g. GA)
Consent form 2
- For an adult consenting on behalf of a child for
procedures where consciousness is impaired
Consent form 3
- For an adult or child for procedures where consciousness is not impaired
Consent form 4
- For adults who lack capacity to provide informed consent
Can young children and older children consent for themselves? (OPIC but saw young ppl in LD)
They must be deemed Gillick competent to consent for themselves
Who can consent on behalf of a child? (OPIC but saw young ppl in LD)
British Law says biological mother can always provide consent.
Childs father can if he is the biological father can if parents are married
Father who is named on birth certificate can, irrespective of marital status
How does the Mental Capacity Act of 2005 differ from the Mental Health Act?
Mental Health Act - for mental health coniditions
Mental Capacity Act - physical health conditions
What does the Mental Capacity Act of 2005 set out?
Provides information on procedures to be followed if pt does not have capacity.
Provides legal authority for persons to make decisions on their behalf
What must a person be able to demonstrate in order to have capacity?
- They must be able to understand the information surrounding a decision and its consequences
- They must be able to retain the information long enough to make a decision
- They must be able to use the information, by weighing up the pros and the cons of the decision
4.They must be able to communicate the decision
As a doctor how should you approach making a decision when a patient lacks capacity?
Make the care of the patient your first concern
Treat patients as individuals and with dignity
Support patients in their decisions
Do not discriminate against patients
What is it important to consider when making deicisons on behalf of someone who lacks capacity?
Whether the lack of capacity is temporary or permanent
Which option provides the best clinical benefit
The views of anyone with legal authority to make decisions on behalf of the patient
Any advance statements or opinions on treatments already offered by the patient
What are some points on the GMC guidance for assessing capacity? lots ….
- Keep up to date with policies / laws
- Always presume capacity
- Don’t assume no capacity due to age / disability/ appearance / behaviour / apparent inability to communicate
- Capacity can fluctuate with disease severity
- Plan ahead - discuss treatment options when pt is able to listen and use the information
- If pt is likely to have difficulty retaining info, give a written record
- Advanced refusals of treatment must be recorded, signed and witnessed
- If assessment reveals borderline capacity, seek help from other healthcare professionals who know the pt.
In an emergency can you treat a patient without their consent?
YES
IF- immediate and probable threat to their life or a serious deterioration of their illness
Tell them what has been done as soon as they are able to understand
What is a lasting powers of attorney (LPA)
LPAs are appointed by patients under the Mental Capacity Act BEFORE they lose their capacity.
They can make decisions on their behalf. The LPA cannot make treatment decisions if the patient still has capacity
What is DoLS?
Deprivation of Liberty Safeguards - under the Mental Capacity Act 2005
These relate to people who lack the mental capacity to make decisions about their care and treatment and who are deprived of their liberty in a care home or hospital
What are the 5 key principals that underpin the Mental Capacity act?
- Presumption of capacity unless established they lack it - assess capacity for each decision as capacity may change e.g. complex question
- Right to be supported to make your own decisions, all practical steps have been made to support this
- Right to make eccentric or unwise decisions
- Decisions made under the act must be made in the pts best interests
- Least restrictive intervention to the pts rights and freedom of actions
The Deprivation of Liberty Safeguards (DOLS) sets out what criteria that hospitals and care homes must meet if they believe it is in a pts best interest to deprive them of liberty?
that the arrangements are in the person’s best interest
the person is appointed someone to represent them
the person is given a legal right of appeal over the arrangements
the arrangements are reviewed and continue for no longer than necessary.
What is a deprivation of liberty?
A person is under continuous supervision and control in a care home or hospital, is not free to leave, and the person lacks capacity to consent to these arrangements.
Give 2 examples of DOLS in practice?
- Giving a dementia patient covert medication e.g. cardiac to prevent deterioration / essential treatment.
- pts with dementia are ‘locked’ in a residential home to prevent wandering out at night
What is the difference between expressed and implied consent?
Expressed consent: typically given with words, e.g. on paper or verbally
Implied consent: understood through actions e.g. the patients actions reflect their consent to the treatment or procedures
Define mental capacity
Ability to make decisions
capacity can involve personal welfare, healthcare and financial decisions.
Mental capacity is
- time specific
- decision specific
what is meant by this?
- Time specific
the principals of the act must be applied each time a decision needs to be made - Decision specific
capacity needs to be assessed for each decision separately. May have capacity for some decisions but lack capacity in other areas.
Why might pts lack capacity?
If mind is impaired or disturbed in some way
- Schizophrneia
- Bipolar
- Dementia
- Severe learning difficulties
- Brain damage e.g. stroke / brain injury
- physical conditions causing confusion, drowsiness or loss of consciousness
- Intoxication - drugs / alcohol misuse
What is the two-stage capacity test?
- Diagnostic test
- Capacity test
What is involved in the diagnostic test aspect of the two-stage capacity tests?
Is there a disorder of the mind? Do we think it will be resolved? Is there time for this condition to be treated to allow pt to be part of decision?
E.g.
is it delirium? - cant make a decision at the moment
is it underlying cognitive impairment such as Dementia? - may not resolve
is it a Mental health condition? - after treatment would be able to make decision
Outline the capacity test in the two-stage capacity test?
- Understand the information around the decision being made and why they need to make it
- Weigh Up the risks / consequences of making or not making the decision
- Retain the information long enough to make a decision
- Communicate that decision. Can be verbally, in written form, using sign language. A SALT may be helpful if this is a barrier
What does the term Deputies appointed by the court of protection mean?
a deputy is authorised by the Court of Protection to make decisions on a person who lacks capacity behalf
- Property and financial affairs deputy
- pay the person’s bills / organise their pension - Personal welfare deputy
- make decisions about medical treatment / how someone is looked after
What is a public guardian?
The role of the Public Guardian is to protect people who lack capacity from abuse
Polices the activities of deputies, attorneys and guardians who act to protect the financial affairs of people who lack the mental capacity for making decisions
What is an Independent Mental Capacity Advocates (IMCAs)
People who can act as an advocate for a person who does not have anyone else to do so, in making a decision.
What is a Independent Mental Health Advocates (IMHAs) ?
An IMHA is an independent advocate who is trained in the Mental Health Act 1983 and supports people to understand their rights under the Act and participate in decisions about their care and treatment.
Define a mental disorder according to Mental Health Act?
‘any disorder or disability of the mind’
This definition is very wide and covers a range of disorders including schizophrenia, depression, anxiety disorders and eating disorders
Outline section 2 of the Mental Health Act
- purpose
- who can enforce it
- duration
- Purpose
- detain a person with a mental disorder
- needs assessment / medical treatment
- needs to be detained for their own health/ safety / protection of others. - who can enforce
- 2 doctors (1 psychiatrist) + an (AMHP) approved mental health professional - Duration
- up to 28 days
Outline section 3 of the Mental Health Act
- purpose
- who can enforce it
- duration
- Purpose
- detain a person with a mental disorder
- needs to be detained for their own health / safety/protection of others
- treatment cant be given unless detained in hospital - Who can enforce
- 2 doctors (1 psychiatrist) + (AMHP) approved mental health professional - Duration
- Up to 6 months, can be renewed
- second time: up to 6 months
- any time after: for 12 month periods
(no limit to how often can renew section 3)
Outline section 5 (4) of the Mental Health Act
- purpose
- who can enforce it
- duration
- purpose
detain any pt in hospital taking discharge against advice. I.e. risk of harm to pt or others - who can enforce it
Authorised Nurse - duration
Up to 6 hours
During this time the nurse needs to find necessary person to sign a section 5(2) or allow the persons discharge
Outline section 5 (2) of the Mental Health Act
- purpose
- who can enforce it
- duration
- purpose
detain any pt in hospital (Admitted - A&E doesn’t count!) - who can enforce it
Doctor looking after the patient - duration
up to 72 hours
Outline section 136 of the Mental Health Act
- purpose
- who can enforce it
- duration
- purpose
Police to take you / or keep you at a place of safety e.g. hospital / care home / police station / your home - who can enforce it
Police - need to have consulted 2 doctors (1 psychiatrist) + a (AMHP) approved mental health professional - duration
for up to 24 hours, can be extended for a further 12 hours if person has not been assessed.
time starts when pt arrives at the place of safety
Outline section 135 of the Mental Health Act
- purpose
- who can enforce it
- duration
- purpose
police can enter your home and take you / keep you at a place of safety until mental health assessment has been done. - who can enforce it
police - must be accompanied by approved medical health professional or a medical practitioner + warrant - duration
Up to 24 hours can be extended for another 12 hours if not assessed
Outline section 117 of the Mental Health Act
‘section 117 aftercare’ - people kept in hospital under mental health act can get free help and support after they leave
types of services:
- healthcare
- social care and employment services
- supported accommodation
What is a community treatment order under the mental health act?
made by a responsible clinician to give a mental health patient supervised treatment in the community, after they have been in hospital.
Clinician can return you to hospital to give you immediate treatment
Give examples of who is counted a AMHP? (approved mental health professional)
Often - social worker
Nurses
occupational therapists
psychologists.
