Consent, capacity & refusal in adults (law) Flashcards
When is consent needed?
Consent required for any form of medical management- history taking, conducting exam, interventional treatments
What happens if a doctor acts without consent?
May have committed following offences:
1) Criminal offence
- Assault
- Battery
- Common assault (combo)
2) Civil action from patient
- Claim for damages
What are the exceptions to consent?
1) Emergency
2) Implied consent
3) waiver
4) best interests (Mental Capacity Act)
Exception to consent: emergency
Medical emergency whereby obtaining consent would damage patient and genuinely no time to ask patient’s permission
Exceptions to consent:
Implied
Some patients imply consent through actions e.g., lifting up top when asked permission to examine.
Should rely on express consent- oral or written espies for invasive treatment
Exceptions to consent:
waiver
Some patients waive consent- don’t want to know treatment= just want treatment to occur
Be careful who is attempting waiver= fine if patient. More often relative who doesn’t want patient to know details of their condition. Without good reason doctor must not put himself in position to agreeing to such waiver
Exceptions to consent:
Best interests
Certain situations cannot obtain patient permission. May be unconscious or have severe dementia so cannot make decisions.
In situations where patient lacks capacity to give consent=> doctor acts in what he believes is patients best interests
What is valid consent?
Competent person that understands nature of treatment based on info in broad terms without coercion who then gives permission
What is a competent person?
Understand info, retain info, weigh up, communicate decision
Competence decision specific i.e., info patient must understand is info relevant to discussion. So patient may have ability to understand consequences of treating pneumonia but not to make will
What are the consent presumptions for adults and children?
Adults (>16)
assumed to have mental capacity to make decisions regarding treatment unless contrary evidence
Children (<16)
assumed NOT mental capacity to make decisions regarding treatment unless contrary evidence
Between 16-18slightly more complex for refusing treatment- see other module
What is meant by broad terms in valid consent?
Reasonable amount of info= patient fully informed but not overburdened and scared off from potentially useful treatment
What is meant by ‘without coercion’ in valid consent?
Agreement of patient must come from patient alone
Sometimes patient may agree to treatment only under pressure of relative or friend. It is fine to discuss one’s concerns with relatives and friends but coercion not allowed
What should a doctor do if they suspect coercion?
Remove patient from coercive environment and repeat discussion
What happens if a patient cannot consent?
Act in patient’s best interests
No-one can consent on behalf of adult lacking capacity unless legal authority granted by Court of Protection
