Consent, Capacity and Refusal in Adults

Question 1

What is the law outlined with reference to consent?

Answer 1

Requires patients to consent to any intervention, and patients with capacity have an absolute right to refuse to consent even if it is not in their best interest (or may even lead to their death)

Question 2

What are the consequences of treating a pt without their consent?

Answer 2

Acting without consent can lead to criminal offence (assault and battery/both) or civil action from patient (claim for damages)

Question 3

What are the exceptions to obtaining consent?

Answer 3

EMERGENCY

Implied consent - through the patient’s actions (lifting top), should rely on express consent (oral/written)

Waiver – some patients don’t want to hear the details and just want treatment to commence.

Best Interests – if it is not possible to gain consent (e.g. unconscious, dementia) or they lack capacity

Question 4

What is needed to insure valid consent?

Answer 4

Must be Competent.

Consent must be given without coercion (if in a coercive environment, the pt should be taken aside and the intervention discussed with them alone)

Major procedures – wise but not legally required to have written consent/oral consent witnessed +signed

Question 5

What is needed for a person to be deemed competent?

Answer 5

> Understand the information (in broad terms – relevant to procedure)
retain the information
use the information to make a decision
communicate the decision

Competence is decision-specific

Question 6

What are the assumptions with competence?

Answer 6

Adults (16+) assumed to be competent unless evidence suggests otherwise

Children (<16) assumed to lack competence unless evidence suggests otherwise

Question 7

Can a patient refuse treatment?

Answer 7

YES:

Competent patients have an absolute right to refusal – no-one can consent on behalf of competent adult

Question 8

What actions should be taken if a patient is not competent?

Answer 8

If the patient fails to meet any of the criteria for competence, they cannot grant valid consent, so the doctor should act in the best interests of the patient

No one can grant consent on behalf of an adult lacking capacity unless they have been granted specific legal authority by the court of protection

Question 9

What should you do if a mother refuses to immunise/ Blood transfusion of a child that is not Gillick competent?

Answer 9

contact father – if he refuses, go to Court of Protection.

If in emergency situation, can override parents if in child’s best interests.