Consent And Capacity Flashcards
What lays out how capacity should be assessed?
The mental capacity act 2005
Who is presumed to have capacity?
People in England and Wales aged 16 and over
Unless evidence otherwise
Why could a person not have capacity?
Due to an impairment of, or disturbance in the functioning of, the mind or brain.
eg dementia, significant learning disabilities, delirium, loss of consciousness and some forms of mental illness
What is necessary to prove capacity in an assessment?
1) No impairment of, or disturbance in the functioning of, the mind or brain
2) Can understand the relevant information
3) Can retain that information long enough to make the decision
4) Can use or weigh up that information in making the decision
5) Can communicate their decision by any means
What if a person refuses treatment?
Patients with capacity are allowed to make unwise decisions
If capacity is questioned, a formal assessment should be done
If the patient lacks capacity. treatment should be by the patient’s best interests
A healthcare worker sustains a needle stick injury from an intoxicated patient. Should a HIV test be done while they lack capacity?
All tests performed on patients who lack capacity can only be done in their best interests. Unless the individual was known to be at high risk of HIV and would benefit from treatment, the test would not be in their best interests.
Consequentialists would argue a blood test causes minimal harm and provides information that will prevent harm to the healthcare worker.
Could wait till they sober up to ask for consent.
When should HIV be tested for?
Routinely where HIV enters the differential diagnosis and where a male patient has disclosed sexual contact with other men.
GUM clinic screening, antenatal clinics and areas where HIV has a prevalence of more than 2/1000 (eg Southampton)
What would be the argument for a student doing an intimate examination on a patient under GA without express consent?
Consequentialists may argue that the overall benefit to society in having well-trained doctors outweighs the harm to individual patients.
Intimate examinations carry no real risk.
(ALWAYS GAIN WRITTEN CONSENT BEFORE ANAESTHESIA FOR EXAMINATIONS UNDER GA)
What needs to be considered when making a decision in the patient’s best interests?
The patient's past and present wishes Clinical needs of the patient Potential benefits and burdens of treatment on persons health and life expectancy All relevant circumstances What is the 'least restrictive' option
What is an LPA and which one is involved in healthcare decisions?
An LPA is a lasting power of attorney. A personal welfare LPA is a legal document which allows a person to appoint someone (the attorney) to make healthcare decisions for them in the event of loss of capacity.
Authority for decisions about life sustaining treatment needs to be stated in the LPA.
Who is an IMCA?
An independent mental capacity advocate represents the views of vulnerable people lacking capacity to make important decisions about serious medical treatment when there are no family members or friends who can be consulted.
Ensure best interests and can see relevant healthcare records.
Can challenge decisions
Usually when pt will stay in hospital longer than 28 days
What is DoLS?
Deprivation of Liberty Safeguards is part of the MCA
It applies to those people who are deprived of their liberty, who lack capacity to consent to that deprivation, and whose deprivation is not covered by the mental health act.
What does deprivation of liberty mean?
If:
The person is subject to the continuous supervision and control of those caring for him/her
The person is not free to leave, were they to try to do so
What does NOT matter when determining if deprivation of liberty is taking place?
The person’s compliance/lack of objection
The relative normality of the placement
The reason(s) or purpose behind a particular placement (does not matter if its for the benefit of the person)
Who needs to be approved under the DoLS legislation?
People who’s liberty is being deprived (under continuous supervision and control and not free to leave)
Applies to patients in all hospitals, hospices and care homes, aged 18 or over who:
-Suffer from a ‘mental disorder’ (in section 1(2) of the MHA, excluding drug and alcohol dependency)
-Lack the capacity to give consent to the arrangements made for their care and treatment
-Can only be given such care and treatment in circumstances that amount to a deprivation of liberty
-Require such a regime as a necessary and proportionate response in their best interests to protect them from harm
