Consent and Capacity

Question 1

what is the 5 parts of capacity

Answer 1

to communicate decisions

to understand decisions

to retain memory of decisions

to make reasoned decisions

to act (e.g. to give consent)

Question 2

what are 6 elements of consent needs to be

Answer 2

valid

with capacity

informed

voluntary

not coerced

not manipulated

Question 3

what is capacity

Answer 3

power to act/make a decision

Question 4

what are the 4 needed elements fo capacity

Answer 4

Reasoned – pt has reasons,

Communicate the decisions
English may not be first language

Understand what they want
Informed

Retain Memory of decisions

Question 5

what is reasoned consent

Answer 5

not random, impulsive, not thought about
- May not agree with reasoning

Cannot go against what pt wants for themselves
- You don’t have to go along with them – but person needs to make their own decision

Question 6

why is the pt being able to communicate with you important in consent

Answer 6

Not got capacity to convey what they want – need interrupter

Need to trust them – avoid family members

Question 7

why is a pt understanding of tx important to consent

Answer 7

Age – young have power to make decision for certain things but some they do not have understanding to make decisions

E.g. teen gender reassignment

Question 8

why is important to consider if a pt can retain memory long enough for giving consent

Answer 8

Long enough – depends on context, pt, judgement and experience

Community dentistry in care home – may be more appropriate to have morning treatment

Question 9

what are the 2 basic requirements of consent

Answer 9

Valid and lawful

In date
- Still current – still OK with it, check if time between appointments

specific to planned treatment
- cannot do anything that has not been consented to by pt that is not in treatment plan
separate consent for different restorations

Question 10

what are 2 elements that contribute to valid consent

Answer 10

capacity

informed

Question 11

when would you question a pt capacity to valid consent

Answer 11

young patient – may need parent/legal guardian

Question 12

why is it crucial pt is informed when giving consent

Answer 12

illegal if pt not fully aware and clear on what the Tx plan is

Question 13

what are the 3 elements that make up lawful consent

Answer 13

voluntary

• what pt actually wants
• —–not dentists, family etc

not coerced/ forced

• by not giving all the possible options
• give Private Tx only when NHS options available

not manipulated
- lead them into what you want to do
- induce – persuasion tactics
not lawful, not a free choice

Question 14

what are the 3 things risk communication should reflect

Answer 14

likelihood (probability_

severity

significance to pt (material risks)

Question 15

what could the possible options be for likelihood of risk

Answer 15

very
not
unknown

Question 16

what could the possible options be for severity of risk

Answer 16

known?
major
minor

Question 17

what could the possible options be for material risk

Answer 17

what is imp to pt
- personal

Pain so unable to do daily tasks e.g. work
- Need to ensure they know prior

pain/swelling very likely – don’t know severity

Nerve disturbances – can tell how they lie in relation to root – can tell if inferior dental nerve disruption is low or high risk but don’t know severity
Sense of taste – low risk but could be a material risk for pt (permanent or not – is unknown )

Question 18

what would the practionener be doing to pt if didn’t have consent

Answer 18

assault

Question 19

definition of consent

Answer 19

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, including the likelihood of its success and any alternatives to it. Consent under any unfair or undue pressure, or where the person does not know what the intervention entails, is not ‘consent’

Ongoing – continue to agree what’s happening

Capacity for intervention in question

Risk communication

Need to know what they are getting into
-Cannot just go along with

Question 20

9 GDC Principles

Answer 20

Put patient’s interest first
Communicate effectively with patients

Obtain valid consent

Obtain valid consent before starting treatment, explaining all the relevant options and the possible costs

Have a clear and effective complaints procedure

Work with colleagues in a way that is in the patient’s best interests

Maintain, develop and work within your professional knowledge and skills

Raise concerns if patients are at risk

Make sure your personal behaviour maintains patients’ confidence and the dental profession

Question 21

3 sub sections of principle 3

Answer 21

OBTAIN VALID CONSENT

Make sure that the patients (or their representative) understand the decisions they are being asked to make

Make sure that the patient’s consent remains valid at each stage of the investigation or treatment

Maintain and protect patients’ information

Question 22

3 conditions for valid consent

Answer 22

Was obtained recently enough

Remains current (patient still agrees)

Specific to the proposed dental treatment

Question 23

factors in how long does valid consent remain valid

Answer 23

Consent should be perceived as a continuing process rather than an irrevocable, one-off decision

Where there has been a significant interval between the patient agreeing to a treatment option and its start, consent should be renewed

In the intervening period, the patient may have changed his or her mind or there may have been clinical developments
- E.g. pregnancy - So consented treatment no longer the best option

It is therefore important that the patient is given continuing opportunities to ask further questions and to review the decision

Question 24

3 principles of legal consent

Answer 24

Ability
- The patient has the ability to make an informed decision

Informed
- The patient has enough information to make a decision

Voluntary

• The patient has made the decision
• What they want

Question 25

5 components of capacity

Answer 25

To act i.e. to decide

To retain the memory of a decision

To understand a decision

To communicate a decision

To make a reasoned decision

Question 26

who has the ability to consent

Answer 26

Any patient with capacity has the ability to give or to withhold consent
- Do not need to have if they do not wish

There is a presumption of capacity in all patients from age 16 unless they are assessed otherwise r

Parental responsibility ends at age 16 (in Scotland) or age 18 (in England & Wales)

No other person may lawfully give consent on behalf of a patient who has capacity
- E.g. proxy if elderly patient using adult kids

Question 27

who is classed as a child

Answer 27

Patients under 16 with sufficient maturity and intelligence to understand the nature and implications of the proposed treatment are deemed to have capacity

Question 28

which adults can give consent for children

Answer 28

Mum
- automatic

Dad
- must be married to mum
named on birth certificate after 4 May 2006 (Scotland), 15 Apr 2002 (N.I.), 1 Dec 2003 (E&W)

Others (including step-parents, caregiver granparents)
- requires court authority, parental responsibility agreement, or adoption; similarly foster parents

Parental responsibility is kept after divorce, but it is lost when giving children up for adoption
- unless taken off them e.g. child protection

Question 29

do dentists need consent of both parents

Answer 29

no - no legal obligation

even if disagreement
- can be challenged in a court - withhold treatment until decided

Question 30

can a parent give parental responsibility to another adult looking after child

Answer 30

Although parental responsibility cannot be handed over to another person, it is possible for someone looking after the child to act on behalf of the person with the parental responsibility when given explicit permission to do so, and the authority can be made in spoken or written form

• What is reasonable to do – for safety of child
• think could you be criticised for not checking

Question 31

what can adult do if child is in their care but parent cannot be contacted

Answer 31

person who otherwise has the care of the child may do what is reasonable for the child’s welfare, such as arranging treatment for dental trauma when a parent cannot be contacted, provided the parent wouldn’t refuse

take to place of care

Question 32

3 factors of informed consent

Answer 32

Sufficient information must be communicated (not ‘given’) so that the pt can make an informed decision about whether or not to accept the proposed treatment based on appropriate knowledge and understanding

Specific questions must be answered fully and honestly
- Rarely happens due to time pressure

Information given should be documented carefully
- Not in the notes, didn’t happen

Question 33

8 things pt may want to know about tx

Answer 33

Options for treatment, the risks and potential benefits

Why you think a particular treatment is necessary and appropriate for them

The consequences, risks and benefits of the treatment you propose

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

Question 34

material risk

Answer 34

Patient’s individual needs and wishes should be considered

the dentist is aware, or should reasonably be aware that the particular patient, if warned of the risks, would be likely to attach significance to these

i. e. what is important to this particular patient
- would it matter to them

Question 35

mode of obtaining consent

Answer 35

Consent may be implied or explicit
- E.g. say ‘open wide’

Implied consent may be sufficient for minor procedures rare

Explicit consent is required for major or invasive procedures

Oral and written consent are equally lawful — the most important factor is a properly documented record showing all the pre-treatment steps have been taken

Forms can be easier – but was it a proper voluntary informed decision
- BUT remember — a signature is only a signature!

Written consent is required for general anaesthetic or conscious sedation

Ensure written consent is filed safely
- Lost = no consent

Question 36

when is consent not needed

Answer 36

When an emergency arises in a clinical setting and it is not possible to find out a patient’s wishes, you can treat the patient without consent, provided the treatment is immediately necessary to save their life or to prevent a serious deterioration of their condition

• Need to be emergency – save life of prevent serious deteriotaion
• —Half an hour from tooth knocked out to save it -Reasonable to consider patient would want it saved

The treatment you provide must be the least restrictive of the patient’s future choices
- Not irreversible unless absolutely necessary

For as long as the patient lacks capacity, you should provide ongoing care; if the patient regains capacity while in your care, you should explain what has been done, and why, as soon as the patient is sufficiently recovered to understand
- Supportive care can be without consent