Consent and Capacity Flashcards
what is the 5 parts of capacity
to communicate decisions
to understand decisions
to retain memory of decisions
to make reasoned decisions
to act (e.g. to give consent)
what are 6 elements of consent needs to be
valid
with capacity
informed
voluntary
not coerced
not manipulated
what is capacity
power to act/make a decision
what are the 4 needed elements fo capacity
Reasoned – pt has reasons,
Communicate the decisions
English may not be first language
Understand what they want
Informed
Retain Memory of decisions
what is reasoned consent
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
why is the pt being able to communicate with you important in consent
Not got capacity to convey what they want – need interrupter
Need to trust them – avoid family members
why is a pt understanding of tx important to consent
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
why is important to consider if a pt can retain memory long enough for giving consent
Long enough – depends on context, pt, judgement and experience
Community dentistry in care home – may be more appropriate to have morning treatment
what are the 2 basic requirements of consent
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
what are 2 elements that contribute to valid consent
capacity
informed
when would you question a pt capacity to valid consent
young patient – may need parent/legal guardian
why is it crucial pt is informed when giving consent
illegal if pt not fully aware and clear on what the Tx plan is
what are the 3 elements that make up lawful consent
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
what are the 3 things risk communication should reflect
likelihood (probability_
severity
significance to pt (material risks)
what could the possible options be for likelihood of risk
very
not
unknown
what could the possible options be for severity of risk
known?
major
minor
what could the possible options be for material risk
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 )
what would the practionener be doing to pt if didn’t have consent
assault
definition of consent
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
9 GDC Principles
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
3 sub sections of principle 3
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
3 conditions for valid consent
Was obtained recently enough
Remains current (patient still agrees)
Specific to the proposed dental treatment
factors in how long does valid consent remain valid
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
3 principles of legal consent
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
5 components of capacity
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
who has the ability to consent
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
who is classed as a child
Patients under 16 with sufficient maturity and intelligence to understand the nature and implications of the proposed treatment are deemed to have capacity
which adults can give consent for children
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
do dentists need consent of both parents
no - no legal obligation
even if disagreement
- can be challenged in a court - withhold treatment until decided
can a parent give parental responsibility to another adult looking after child
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
what can adult do if child is in their care but parent cannot be contacted
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
3 factors of informed consent
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
8 things pt may want to know about tx
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
material risk
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
mode of obtaining consent
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
when is consent not needed
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
