Consent Capacity and DOLS Flashcards
What is consent in relation to healthcare?
A person’s agreement for a health care professional to provide care.
Can consent be withdrawn at any time?
Yes
What types of consent are there? (2)
Consent from the patient,
consent of another person who is authorized to consent on the patients behalf and have the defecne of neccesity (consent in an emergency setting)
What are the elements of consent?
Information, voluntariness and capacity/ competance.
describe the element of consent - information.
Nature of the assessment or treated being proposed must be understood by the patient.
Describe the element of consent - voluntariness.
Consent must be given voluntarily
Describe the element of consent - capacity/competance.
Capacity must be present in the patient.
What does the mental capacity act state?
You should presume a patient has competancy unless there is evidence that they do not.
What are some examples where capacity may be uncertain?
mental health conditons such as bipolar, serious learning disabilities, medical conditions such as severe infection, hypoxia, intoxication and delirium.
What are the 5 principles of the mental capacity act 2005
A person must be assumed they have capcity unless its established that they do not,
A person is not to be treated as unable to make a decision unless all practical steps to help them have been taken without success,
A person is not to be treated as unable to make a decision merely becasue they make an unwise one.
An act done or decision made on behalf of this patient must be done in their best interests.
Before this act is done, regard must be had to whether the purpose for which it is needed can be achieved in a way that is less restrictive of the persons rights and freedom of action.
What is good practice when helping a patient make a decision?
Using simple terminology, using information in their own language, consult with those who know the patient well, choose appropriate setting and time, and consider waiting for the patients capacity to return if this is fluctuating.
What can you use to assess capacity?
JRCALC
What is the first stage of assessing capacity?
The diagnostic test - section 2(1) of the mental capacity act 2005
What does the diagnostic test for capacity involve?
Assessing if the patients have any imparements
What is the second stage of assessing a patients capacity?
The functional test (section 3 (1)) of the mental capacity act 2005
What is the critera of the functional test?
A person is unable to make a decision if they are unable :
– to understand the information relvant to the decision
– to retsin that information
– to use or weigh that information as part of the process of making the decision
– unable to communicate their decision.
How can consent be given?
Written, Verbal, implied
When do you not need valid consent?
When a patient lacks capacity, additional procedure, emergency treatment (doctrine of neccesity), mental health condition, risk to public health, severly ill and living in unhygeinic conditions
What does it mean duty of care?
The absolute responsibilty of a healthcare professional to treat and care for a person with a reasonable degree of skill and care.
What should you consider with best interests?
–Consider all relevant circumstances
–is it safe to wait until the person can give consent
– Involve the person with the decision making as much as possible
– determine whether the person has previously expressed opinionms regarding certain procedures.
– if possible consult other people in the persons immediate family
What acts are relevant to consent, capcity and DOLS?
Mental health act 2007, mental capacity act 2005, court of protection and the Human rights act 1998
What does DOLS stand for?
Deprivation of Liberty Safeguarding
What do DOLS state?
– should be avoided whenever possible
– should only be authorised in cases where it is relevant to the pts best interest and the only way to keep them safe
– should only be for a patricular treatment plan
– should be for as short time as possible
What is the conditions that allow DOLS to be put into place?
– Patient is 18 or over (different safeguarding for children)
– The person is suffering from a mental disorder
– The person lacks capacity to decide for themselves about the restrictions that are proposed
– The restrictions would deprive the person from their liberty
– Proposed restrictions are within the pts best interest
– whether the person should be considered for the detention under the mental health act instead
– no valid advance decision to refuse treatment ot support that would be overidden by any DOLS process,
What is acid test for deprivation of Liberty?
A supreme court in 2014 made reference to the acid test to see whether a person is being deprived of their liberty. It consisted of 2 questions:
- is the person subject to continous supervision and control
- is the person free to leave
What is Gillick Competancy
Unde the age of 16 and have enough intelligence, competance and udnerstanding fullt the risks or benefits to their treatments.
Give examples of people who may lack capacity
Dementia
Mnetal illness
severe learning disbaility
acute illness such as a uti
What are the key elements for consent to be valid?
Voluntary, informed, mental capacity
What is the mental capacity act 2005?
To protect and empower people who may lack capacity to make their own decisions about care. Applies to people over 16.
What is the court of protection?
Oversees operation of MCA 2005, deals with issues and disputes. Used for both health and financial issues.
What is GDPR?
General data protection - formed by the EU ensuring europe fit for the digital age
When can confidentiality be breached?
Serious Crime - murder, manslaughter, kidnapping
Threat to national security - serious harm to the security of the state or public order such as terroism
Risk of Harm - child abuse, neglect, infectious diseases, malaria
What is battery?
Intentionally touching a patient without their consent from a carer or guardian if the pt lacks capacity
What is section 2 for the mental health act 2007?
Hold for assessment for up to 28 days, following this review this must be stood down or upgraded to section 3. section 2 cannot be extended
What is section 3 of the Mental health act 2007
up to 6 months for treatment, can be extended indefinitely
What is section 4 of the mental health act 2007?
Emergency section, 72 hours for assessment. Family or AMHP can apply. must be supported by at least one section 7 approved doctor. used in short notice
What is section 5 of the MHA
Holding powers in hospital to stop leaving.
Section 5 (4) - nurse holding power up to 6 hours up to 6 hours
Section 5 (2) - doctor holding powers up to 72 hours
What is section 135 MHA
Applied for by AMHP
Warrent issued by local magistrate
allows police to enter patient property
to remove patient to place of safety for MH assessment
can be kept in place of safety for 24 hours plus 12 hour extension if required
What is section 136 MHA
Allows police to detain pt in public place suffering MH disorders and at risk to self and others.
Up to 12 hours, 12 hour extension if required
What should you do if a patient lacks capacity?
Protect and empower. Act in their best interest and follow the 5 MCA principles
What are the types of lasting power of attourney?
Health and welfare
Property and financial
What is a LPA
A person that makes decisions on behalf of another when they lack capaity. LPOAS registered with the office of the public guardian. Must be in place before the patient loses capacity.
Explain the two main policy aims of the marmot review
To create am enabling society that maximises individual and community potential
To ensure social justice, health and sustainability are at the heart of all policies
Explain the social determinants of health in the marmot review
health inequlaities, february 11th 2010. Adresses the conditionas people are born, grow, live, work and age in that can lead to health inequalities
