Consent AWI Flashcards
Capacity
Understand what the tx is
B + R and alternatives
consequences of not having a tx
retain the information
communicate the decision to the others
hold decision consistently
5 Principles of AWI
- Any action taken on behalf of the person, must benefit that person
- Least restrictive option, that will achieve the desired effect
- Person’s past and present views and preferences must be taken into account
- Also views of specific persons (such as guardians, attorney, relative or anyone else with interest in that person) should be taken into account
- Encourage the adult to develop and exercise as much skill as possible in making decisions. All steps must be taken to enhance the person’s decision making ability
Adults with Incapacity (Scotland) Act 2000
Welfare
Property
Financial
Medical
Proxy decision makers
Managing affairs in the future should capacity to make decisions be lost
continuing PoA
can only manage the finances and property of another person
powers can start immediately after the agreement signed
or the Granter can specify the powers should start only when they have lost capacity to manage their own finances
dental relevance: when patient who needs new denture may consent and understand the treatment, but they may not understand that they need to pay for it, the cost or financial involved, so a continuing power of attorney may need to be involved
determining incapacity
no single universally accepted test
specific requirements in relation to consent for medical treatment under part 5 of AWI act
must determine if the person is:
capable of making and communicating their choices
understands the nature of what is being asked and why
has memory abilities that allow retention of information
is aware of any alternatives
has knowledge of the risks and benefits
is aware that the information is of personal relevance to them
is aware of the right to refuse as well as the consequences of refusal
has ever expressed their wishes relevant to the issue when greater capacity existed
is expressing views consistent with their previously preferred moral, cultural and experiential background
is not under influence from a relative, carer or other third party
MUST also apply the 5 principles and consider the person’s past and present wishes, feelings and seek views of relatives or others supporting the person, where reasonable and practicable
Guardianship orders
Will specify what decisions an Attorney or Guardian can make, it may not be all decisions, so important to check the paperwork
Can cover property and financial matters, or personal welfare including health, or a combination of these
Anyone with interest in that person, eg family member or social work, can only be applied for when the person is assessed as not having capacity anymore
Incapacity
Person is incapable of
Acting, making decisions, communicating decisions, understanding decisions, retaining the memory of decisions
Capacity may be diminished temporarily or permanently, partially or totally
The law in Scotland presumes all adults 16 years and older, have sufficient capacity to decide on their own medical treatment
Intervention order
A one-off decision in situation, where a person does not have the capacity to consent for example in case of complex medical treatment, although they can still make most other decisions
Dental relevance: pt with complex psychiatric history, requires full clearance under GA due to extensive caries, multiple periapical and recurring abscesses
Power of Attorney
Person granted the authority to make decisions on behalf of a person who becomes incapable of decision making on their own. They have legally named the person who should be making decisions on their behalf, when they still had capacity
2 types
Continuing attorney
Welfare attorney
All continuing and welfare PoA must be registered with the Office of Public Guardian
Welfare attorney (proxy decision makers)
Have the power of a person’s personal welfare, so anything that affects the person’s physical and emotional wellbeing, this could be medical care, choice of diet, personal care, clothing, meaningful social contact
Welfare attorney can start making decisions on behalf on the person, once the person has been assessed and agreed they no longer have capacity
Welfare attorney must be granted authority by the person, before they loose capacity
What can influence person’s capacity?
Previous experiences
Information they are given- we need to give as much as we can, as they can only consent if they understand all, incl R + B, alternatives, consequences of not having a treatment
Communication - is really important how we get the information across to them
In pain or medications they take
Conditions such as pneumonia, UTI, delirium
What support they have in place
Other people affecting or influencing their decision making?
What does Certificate of Incapacity must include?
How long is it valid for
Must be signed and dated
Treatment specific- it’s length should reflect thus
Max period is 3 years
Can be cancelled or changed, should the person’s condition or circumstances change
Good practice to attach a written tx plan
If person who does not have capacity, has a proxy who can give consent, the S47 certificate must still be completed
If proxy refuses consent, treatment cannot go ahead and practitioner must contact the Mental Welfare Comission for a 2nd opinion
What should be completed if person is deemed not to have capacity to consent?
The certificate of Incapacity under section 47 of AWI (Scotland) Act 2000
Part 5 of the AWI act - section 47
Grants the practitioner the general authority to give medical treatment to an adult, who lacks capacity to give or refuse treatment
Decision regarding capacity to consent should be based on assessment at the time, rather than existence of the adult’s diagnosis or disability
Capacity to consent must be considered with respect to a specific decision and for a given moment in time
