Consent, Capacity, Confidentiality and Children

Question 1

R v Dr Flattery

Answer 1

• Dr said breaking a womans hymen would stop her fits
• She didn’t understand what this meant but consented
• Resulted in him being convicted of rape.

Question 2

Function of the GMC

Answer 2

Maintain a list of doctors

Question 3

Function of the BMA

Answer 3

Trade union

Question 4

Function of the MPO

Answer 4

Medical protection organisations (MDU, MPS)

Question 5

Function of the NHS

Answer 5

Provider of health services

Question 6

Function of the CQC

Answer 6

Ensure quality (care quality commission)

Question 7

Function of the NICE

Answer 7

Ensure value (national institute for clinical excellence)

Question 8

Compare common law and statue law

Answer 8

Common law

• Based on tradition (custom before 1066)
• Heavy weight on judicial interpretation (cases - looks at decisions made in similar cases)

Statute law

• Laws passed in parliaments
• Effectively include executive powers by government agencies

Question 9

Compare criminal and civil law

Answer 9

• Criminal law is offences that negatively affect society as a whole, rather than just one person.
• Civil law is behaviour that causes injury to a person or group of people (eg. negligence)

Question 10

Describe the process of civil law

Answer 10

• Remedy is compensation (people want money)
• Claim for damages
• Two parties with a relationship but no contract (tort law - civil wrong)
• Aggrieved party = claimant
• Defending party = defendent
• Less than 1% go to trial

Question 11

Describe the process of criminal law

Answer 11

• State punishes wrongdoer
• Police investigate
• Crown prosecution services
• Judge and Jury

Question 12

Which specialities are more commonly claimed against?

Answer 12

• Obs and gynae highest cost value

- Surgery the most frequently claimed for

Question 13

Describe the court hierarchy

Answer 13

• Coroners court (unnatural deaths)
• Crown court progresses to court of appeal then to high court (criminal)
• County or high court (civil)

Question 14

List exceptions to consent

Answer 14

• Emergency
• Implied (eg. sticking arm out for blood pressure cuff)
• Waiver (do what you want, I’m not fussed)
• Best interests

Question 15

List presumptions for consent in adults

Answer 15

(Age 16 over)

• Are assumed to have mental capacity to make treatment decisions
• Unless there is contrary evidence

Question 16

List presumptions for consent in children

Answer 16

(less than 16_

• Assumed to not have mental capacity
• Unless there is contrary evidence

Question 17

List components of valid consent

Answer 17

A competent person who understands the nature of the treatment based on information about risk without being coerced

Question 18

List the 4 things that must happen for competence to be met (in MCA test)

Answer 18

• Understand the information
• Retain the information
• Use the information
• Communicate the information

Question 19

List 5 key principles of mental capacity act 2005

Answer 19

• A presumption of capacity in every adult
• Right for individuals to be supported to make their own decisions
• Right to make eccentric or unwise decisions
• Best interests (everything done for or on behalf of people with no capacity must be in their best interests)
• Intervention must be least restrictive of their basic rights and freedoms

Question 20

What is the medical capacity assessment test for capacity?

Answer 20

• A single clear test for assessing whether a person lacks capacity to take a particular decision at a particular time
• Decision specific test
• No one can be labelled incapable due to a particular diagnosis

Question 21

Describe the case of bolam

Answer 21

• Hospital failed to give Bolam muscle relaxant, didnt warn them the risks of the procedure, he was not strapped down and he fitted
• Doctor was not held responsible in negligence as he was held to be acceptable to a reasonable body of other doctors

Question 22

Describe the case of Sidaway

Answer 22

• Surgery for neck and shoulder pain
• 1-2% risk of nerve root damage, lower risk of paralysis
• Not told of paralysis risk and she ended up being paralysed
• Surgery was performed competently
• Tried to sue the surgeon but was unsuccessful as other doctors said he did procedure correctly (bolam)

Question 23

Describe the case of bolitho

Answer 23

• 2 year old with respiratory infection
• Drs didn’t come when asked to attend
• Dr came later but child had cardiac arrest and had brain damage
• If intubated would have not happened
• Dr would not have intubated if he came earlier, so was not wrong

Question 24

Describe the montgomery case

Answer 24

• Montgomery diabetic
• During delivery complications
• Shoulder dysplasia occured, hypoxic insult and cerebral palsy occured
• Obstetritian didn’t say there was increased risk of this in diabetic women (10%), even after she asked
• She sued for negligence and said she would have had a c section if she knew
• Redefined standards for informed consent, rejected Bolam

Question 25

Define a material risk

Answer 25

In the circumstances of the particular case, a reasonable person in the patients position would attach significance to that risk

Question 26

List different aspects of material risk

Answer 26

- Doctor doesn't have to disclose if not in the patients best interest - Also in necessity (eg. unconscious or urgent treatment) - Patient should make decision whether to undergo decisions - Assessment of material list cannot be reduced to percentages

Question 27

Describe the spence v hillindon case

Answer 27

- Patient had bilateral pulmonary emboli after a hernia operation - He didnt seek treatment immediately due to not being advised of risk of DVT or PE or symptoms that might indicate these - The judge found failure to inform the patient was a breach of duty of care - Montgomery applied

Question 28

Describe the case of T

Answer 28

- 24 wks pregnant, RTA - Mother Jehovas Witness patient was not - Mother convinced patient to not have a transfusion, signed a form refusing consent to have it - It wasnt explained she may need one to save her life - Put on a ventilator - Her father and boyfriend applied to the court so she could have the transfusion, and it was deemed lawful to give blood - This is because the mother influenced her decision and she didnt know how much she needed it