Consent, capacity and competence Flashcards
3 phases of decision making
- gathering information
- recalling and pooling the information
- weighing things up
Adverse effects on decision making
- not being competent
- being coerced or put under pressure
- being deceived or having information concealed from you
Autonomy
The right to make one’s own decisions about important issues, and define oneself through one’s choices. Allows us to live according to our own values and beliefs, and is strongly linked to identity.
Self-determination theory
A field of psychology dealing with motivation, which links the notions of wellbeing, satisfaction and performance to the central ideas of autonomy, competence and relatedness.
GMC 7 key principles of consent
1) the right to be involved and informed in decision making
2) a focus on meaningful dialogue
3) the right to be listened to
4) finding out what matters to the patient
5) presuming capacity in adults
6) choices must benefit patients who lack capacity
7) patients whose right to consent is affected by law should be supported to be involved in decision making
The law and consent
The legal basis for consent is found within Common Law. There is a duty to provide enough information for the patient to make a balanced judgement, including providing alternatives and informing of common or serious consequences.
Sidaway vs Bethlem Royal Hospital Governors (1985)
Court ruled against a patient whose shoulder was paralysed during surgery, as the risk was so low.
Montgomery vs Lanarkshire (2015)
Court ruled in favour of a diabetic mother whose baby developed cerebral palsy after she was not informed of the risk of shoulder dystocia during childbirth.
GMC guidance on consent
You must give patients clear, accurate and up-to-date information, based on the best available evidence, about the potential benefits and risks of harm of each option, including the option to take no action.
Validity of consent
Consent is only valid if the patient is informed, competent, and makes the decision voluntarily without coercion. It can expire, and only applies to the specific decision for which it was given.
Situations where you cannot get consent
- emergency treatment of an unconscious/incapacitated patient
- urgent mental health treatment under the Mental Health Act
In these situations, you must always act in the patient’s best interests, and, if possible, according to what they would want.
The ‘therapeutic exception’
A theoretical situation in which giving the information necessary for informed consent would cause ‘significant psychological harm’ to the patient.
Capacity
The ability to make one’s own decisions. Relies on being able to:
- understand the presented information
- recall the information
- weigh up the decision
- communicate the decision
Assessing capacity
Capacity must be assessed, as you must presume that every adult patient has capacity. Also, capacity should be assessed, and you should not ignore signs that a patient lacks capacity.
Arskaya vs Ukraine (2013)
The European Court of Human Rights ruled that there had been a breach to the right to life, after a vulnerable patient clearly showing symptoms of a mental disorder was allowed to refuse treatment.
