Consent and Capacity

Question 1

Consent

Answer 1

• Patients have a basic right to be involved in decisions about their healthcare.
• A person needs to understand the nature and purpose of the procedure in order to give valid consent.

Question 2

Types of consent

Answer 2

• Explicit consent
• Implied consent: for example by bringing their prescription to you to be dispensed

Question 3

Obtaining consent

Answer 3

• Information you provide to the patient must be clear so the patient can understand and give consent
• Consider any disabilities or language barriers.

Question 4

For consent to be valid the patient must:

Answer 4

• Have the capacity to give consent
• Be acting voluntarily – they must not be under any undue pressure from you or anyone else to make a decision
• Have sufficient, balanced information to allow them to make an informed decision
• Be capable of using and weighing up the information provided.

Question 5

Mental Capacity Act 2005

Answer 5

Defines a person who lacks capacity as:
at the time is unable to make a decision for themselves because of an impairment or disturbance in the functioning of their mind or brain.

Question 6

A person is unable to make a decision when they cannot do one or more of the following:

Answer 6

a) Understand the information provided
b) Remember the information provided
c) Use or weigh up the information
d) Communicate their decision to you

Question 7

When could a patients capacity be temporarily effected?

Answer 7

• Fatigue
• Panic
• Effects of drugs or alcohol

Question 8

You must not assume that a patient lacks capacity based just upon:

Answer 8

• Age
• Disability
• Beliefs
• Condition, or behaviour

Question 9

Adults with capacity

Answer 9

Every adult is presumed to have the capacity to make their own decisions and to give consent for a service or treatment unless there is enough evidence to suggest otherwise.

Question 10

When a competent adult refuses to give consent

Answer 10

• Respect their decision even if you think its wrong and may cause them harm
• Explain consequences of this decision
• Make detailed record
• Can escalate with colleague/employer if you believe pt is at risk of serious harm

Question 11

Adults without capacity

Answer 11

• Work with people close to them and with other members of the healthcare team.
• Refer to Mental Capacity Act (2005). These set out who can make decisions on the patient’s behalf, in which situations, and how they should go about this.

Question 12

Young person

Answer 12

aged 16 or 17

Question 13

Child

Answer 13

under 16

Question 14

Young people and children and capacity general

Answer 14

• Depends more on the patient’s ability to understand and consider their decision than on their age
• Young person or child may have the capacity to consent to some services or treatments but not to others.
• Assess maturity and understanding individually, and bearing in mind the complexity and importance of the decision to be made.

Question 15

If a person with parental responsibility is required to provide consent, you may need to get legal advice if:

Answer 15

• You are in any doubt about who has parental responsibility for the individual, or
• The views of those that have parental responsibility differ to the young person/ child

Question 16

Young people with capacity

Answer 16

• Young people are presumed to have the capacity to make their own decisions and give consent
• Use the same criteria as for adults to assess capacity
• Encourage young people to involve their parents in making important decisions.
• Respect a competent young person’s request for confidentiality.

Question 17

Children and capacity

Answer 17

• Children are not presumed to have the capacity to consent. They must demonstrate their competence.
• A child can give consent if you are satisfied that the treatment is in their best interests, and that they have the maturity and ability to fully understand the information given and what they are consenting to. In this case you do not also need consent from a person with parental responsibility.

Question 18

When competent young people and children refuse to give consent

Answer 18

• In some circumstances, the courts and parents can override the refusal of consent of a young person
• You should get legal advice if needed on this issue.

Question 19

Young people without capacity

Answer 19

• Parent can give consent on behalf for investigations and treatment that are in the young person’s best interests.

Question 20

Child without capacity

Answer 20

When a child lacks capacity to give consent, any parent or the court, can give consent on their behalf.

Question 21

Consent in an emergency

Answer 21

• If you cannot get consent, you can provide treatment that is in the patient’s best interests
• Exception is if there is a valid and applicable advance decision to refuse a particular treatment