Consent II the incompetent patient Flashcards
What might temporarily affect capacity?
Fear Pain Influence of drugs/alcohol Loss of consciousness (sedation) Heightened emotional state
Groups that may not be able to consent
Incompetent adults
Children
Why might an adult be incompetent?
Temporary due to fear etc etc
Per ent due to mentally handicapped or mentally ill
What does it mean to be mentally handicapped?
(Legal term not medical term). Patients of adult age whose have not reached adult capacity.
Specific laws applying to mental illness
May not be deemed incompetent. Mental health act 2007: only provides treatment without consent relating to the mental illness. Does not allow for treatment unrelated to the mental illness.
Do incompetent adults have proxy consent?
Until recently, If an adult lacks the capacity to consent, no court or person can consent (unless treatment is for mental disorder). But the court can grant a declaration to proceed without consent if the treatment can be justified as being in the best interests of the patient. No proxy consent. Recently, mental capacity act allowed for consent to be given or withheld for medical treatment of patients who lack capacity by another person (close relative). So yes proxy consent.
What is the bolam test?
A negligence test. Does not relate well to beneficence.
What is the mental capacity act 2005
Allows consent to be given of withheld by another person (proxy consent). Does not apply to children under 16yo.
Mental capacity act 2005
Capacity must be assumed unless proven otherwise. Re-stresses best interests.
What is a child?
Under the age of 18. Separate laws of consent for 16+17 to being under 16.
Laws for 16+17
Can give valid consent without regard to their parents wishes, though do not have complete autonomy. Consent can be overridden by court only not parents. Refusal can be overridden by parents and court.
Children under 16 gillick competent
Gillick competence describes children under 16 who have competence. They can consent. The degree of understanding and intelligence required increases with the complexity of the proposed treatment. Court can overrule consent and refusal. Parents can only overrule refusal.
Children under 16 not gillick competent
Consent may be given by anyone with parent responsibility. A court can overrule a parent refusal. If 2 parents disagree advice from court should be taken. When parents cannot be contacted a child can be treated in the best interests without consent. Only one parent needed.
Parent responsibility (childrens act 1989)
Child’s parent of they were married at the time of conception of birth. Child’s mother is they were not married as above unless the father has subsequently acquired parental responsibility by a court order or subsequent marriage. Child’s legal guardian. Any person in whose favour the court has made a residence order. A local authority that has been designated in a care order. A local authority holding a child under an emergency protection order.
Who can do what is reasonable in all circumstances for the purposes of safeguarding or promoting the childs welfare?
Teachers, child minders
