Consent and capacity

Question 1

what is the definition of consent?

Answer 1

the voluntary and continuing permission of an appropriately informed person who has the capacity to consent to the intervention in question, based on a sufficient knowledge of the purpose, nature, likely effects and risks of that treatment, inluding the likelihood of its success anfd any alternatives to it

Question 2

what are the conditions for consent?

Answer 2

consent must be VALID and LEGAL

Question 3

what should valid consent be?

Answer 3

• remains current (patient still agrees)
• specific to the proposed dental treatment only
• was obtained recently enough

Question 4

how long does consent remain valid?

Answer 4

• consent should be a continuing process rather than an irrevocable, one-off decision
• where there has been significant interval between the patient agreeing to a treatment plan and its start, consent should be renewed
• in the interval, the patient may have changed their mind or there may have been clinical developments
• it is important that the patient is given continuing opportunities to ask questions and to review the decision

Question 5

what are the principles osf legal consent?

Answer 5

• capacity - pt has the ability to make an informed decision
• informed - pt has enough information to make a decision
• voluntary - the patient has made the decision

Question 6

what is involved in capacity?

Answer 6

Question 7

what is involved in consent?

Answer 7

Question 8

how old is someone who is presumed to have capacity?

Answer 8

16 unless they are assessed otherwise

Question 9

at what age does parental responsibility end in Scotland?

Answer 9

16 or upon marriage or civil partnership

Question 10

describe children’s ability to consent

Answer 10

• patients under 16 with sufficient maturity and intelligence to understand the nature and implications of the proposed treatment are deemed to have capacity
• if a child does not have capacity, an adult can consent for their treatment but they must have parental responsibility

Question 11

who has parental responsibility of a child?

Answer 11

• mum - automatic
• dad - must be married to mum or named on birth certificate after 4th May 2006
• step-parents - required court authority, parental responsibility agreement or adoption
• parental responsibility is kept after divorce but lost when giving up for adoption

Question 12

what is informed consent?

Answer 12

sufficient information communicated so that the patient can make an informed decision about whether or not to accept the proposed treatment based on appropriate knowledge and understanding
* specific questions should be answered fully and honestly
* information communicated should be documented carefully
* treatment should not exceed the consent given
* patient’s individual needs and wishes should be checked

Question 13

True or False: someone looking after the child can act on behalf of the person with parental responsibilty when given explicit permission

Answer 13

True

Question 14

what are some things that a patient may want to know in regards to their treatment? *

Answer 14

• options for treatment, the risks and the potential benefits
• why you think a particular treatment is necessary and appropriate for them
• the consequences, risks and benefits of the treatment
• the likely prognosis
• your recommended option
• the cost of the proposed treatment
• what might happen if the proposed treatment is not carried out
• whether the treatment is guaranteed, how long it is guaranteed for and any exclusions that apply
• the patient can change their mind at any time

Question 15

what is a material risk?

Answer 15

a risk that a reasonable person in the patient’s position would likely consider significant when deciding whether or not to undergo a treatment

Question 16

what is the difference between an objective risk and a subjective risk?

Answer 16

• objective - what a reasonable person would expect to be told about this particular procedure
• subjective - what is important to this particular person

Question 17

what are the two different types of consent?

Answer 17

• implied
• explicit

Question 18

what can you use implied consent for? give examples

Answer 18

implied consent is sufficient for minor procedures
* sitting down in the chair
* opening her mouth
* voluntarily attending the appointment

Question 19

what is explicit consent needed for? give examples

Answer 19

explicit consent is required for major or invasive procedures e.g. general anaesthetic or conscious sedation
* oral consent
* written consent - document and safely store

Question 20

when is consent not required?

Answer 20

• when an emergency arises in a clinical setting and it is not possible to find out a patient’s wishes
• the treatment needs to be immediately neccessary to save their life or prevent serious deterioration
• the treatment should be the least restrictive of the patient’s future choices
• for as long as the patient lacks capacity, provide ongoing care and if the patient regains capacity, explain what has been done and why

Question 21

if adult patients have incapacity, what act supports them and what can be done for them?

Answer 21

• adults with incapacity act 2000 (Scotland)
• allows people to decide who will handle their affairs if they cannot
• Power of Attorney is authorised if the patient has formally nominated a person for this prior to losing capacity

Question 22

what is the difference between Welfare PoA and Continuing PoA?

Answer 22

• Welfare PoA - for the care and personal needs of the adult (e.g. healtcare, clothing, diet) - only whilst the adult lacks capacity
• Continuing PoA - is for finance and property - no power to make will, gifts, apopint a successor or do anythink not specified in prior agreement

Question 23

if there is no Power of Attorney, what can be put in place?

Answer 23

• an Intervention Order for a one-off decision for an adult with incapacity
• a Guardianship Order for continuous management of the adult’s welfare and/or financial affairs
• both require a Certificate of Incapacity

Question 24

what are the 5 principles of the Adults with incapacity act 2000 (Scotland)?

Answer 24

• the benefit of the adult
• minimum intervention
• present and past wishes of the adult
• consultation with the adult and others
• the adults exercising of their skills and further development of these

Question 25

what are essential conditions in using the Act?

Answer 25

* the **benefit** to the adult **cannot be achieved any other way** * there is no way that would **take less responsibilty away** from the adult * the adult is asked about **present wishes** and others asked for **known past wishes** * the adult, next of kin, carer, appointed PoA or guardian should be **consulted about any action** * the adult **must be encouraged** to do as much as is possible

Question 26

True or False: a patient who is 14 years old can have capacity to consent to specific dental treatment

Answer 26

**True** usually

Question 26

True or False: an adult who has capacity is entitled to demand dental treatment

Answer 26

**False** - no one can demand treatment

Question 26

True or False: an adult patient who has capacity is entitled to refuse specific dental treatment

Answer 26

**True**

Question 27

True or False: it is possible to give consent or to refuse consent for dental treatment on behalf of an adult who has capacity

Answer 27

**False**

Question 28

True or False: if an adult lacks capacity, the next of kin is entitled to give or refuse consent for dental treatment on the patient's behalf

Answer 28

**False** - not entitled, only if PoA determined by incapacitated adult when had capacity