Consent and Capacity

Question 1

Why is consent needed?

Answer 1

‘every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without the patient’s consent commits an assault ‘

Question 2

What us the definition of consent?

Answer 2

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. Acquiescence under any unfair or undue pressure, or where the person does not know what the intervention entails, is not ‘consent’

Question 3

What is included in the third GDC standard: Obtain valid consent? (3 points)

Answer 3

3. 1 - Obtain valid consent before starting treatment, explaining all the relevant options and the possible costs
4. 2 - Make sure that the patients (or their representatives) understand the decisions they are being asked to make
5. 3 - Make sure that the patient’s consent remains valid at each stage of investigation or treatment

Question 4

What are the 2 conditions for consent?

Answer 4

Consent must be BOTH:

• Valid and legal

Question 5

What makes consent valid? (3 points)

Answer 5

• Remains current (patient still agrees)
• Specific to the proposed dental treatment inly
• Was obtained recently enough

Question 6

How long does consent remain valid? (4 points)

Answer 6

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

Question 7

What are the 3 principles of legal consent?

Answer 7

1. Ability (the patient has the ability to make an informed decision)
2. Informed (the patient has enough information to make a decision)
3. Voluntary (the patient has made the decision)

Question 8

What is capacity? (5 points)

Answer 8

• To act (to decide)
• To make a reasoned decision
• To communicate a decision
• To understand a decision
• To retain the memory of a decision

Question 9

Who has the ability to consent? (4 points)

Answer 9

• Any patient with capacity has the ability to give or to withhold concent
• There is a presumption of capacity in all patients from age 16 unless they are assessed otherwise
• Parental responsibility ends at age 16 (in Scotland) or age 18 (in England and wales)
• No other person may lawfully give consent on behalf of a patient who has capacity

Question 10

Do children have the 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
• When an adult is giving consent for a child’s treatment you must be satisfied that the person has parental responsibility
• Parental responsibility is kept after divorce, but is lost when giving up children for adoption

Question 11

What may a patient want to know prior to giving consent? (8 points)

Answer 11

• 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 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 and
• Whether the treatment is guaranteed, how long it is guaranteed for an any exclusions that apply

Question 12

What are material risks?

Answer 12

Are risks where:

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

Question 13

What are the different modes of obtaining consent?

Answer 13

• May be implied or explicit
• Implied consent may be sufficient for minor procedures
• 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
• Written consent is required for general anaesthesia or conscious sedation
• Ensure written consent is filed safely
• BUT remember a signature is only a signature

Question 14

When is consent not required?

Answer 14

• When an emergency arises in a clinical setting and it is not possible to find out the patient’s wishes
• The treatment you provide must be the least restrictive of the patient’s future choices
• 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