Consent in adults and children, emergency and non-emergency situations Flashcards
What is the meaning of medical battery?
Harmful/offensive touching of another person in a medical setting
Give 2 ways in which an operation can constitute medical battery?
Incorrect site of surgery
Wrong operative procedure performed
How can deciding what treatment a patient receives constitute medical battery in 2 ways?
Ignoring a specific prohibition of the treatment, which can be dangerous for patient
Giving unnecessary/additional treatment that isn’t clinically indicated, but doctor thinks its convenient
How can a patient’s consent status constitute medical battery?
Ignoring a patient’s withdrawal of consent
How can patient be appropriately informed about a treatment, regardless of how complex the treatment is?
The more complex the treatment, the more details the patient must be given by clinician
What is informed/medical consent, and what 2 factors must be discussed to constitute this?
Permission granted by patient in knowledge of possible consequences
Need to discuss material risk, any complications
Must consent be given voluntarily by the patient?
Yes, not under influence, coercion, duress
Give 3 ways in which consent is made patient-centered in a consultation?
Clinician involves patient in dialogue
Clinician listens to patient’s choice
Clinician supports patient’s right to individualism
What Act provides principles on how an individual without capacity can give consent?
Mental Capacity Act 2005
How many key principles are in the Mental Capacity Act 2005?
5
Describe the principle ‘presumption of capacity’ of Mental Capacity Act 2005?
Must assume that an individual has capacity unless proven otherwise, and can’t assume that an individual doesn’t have capacity because they have an illness/disability
Describe the principle ‘Right to support when making decisions’ of Mental Capacity Act 2005, and list 3 ways in which this is applied?
Maximise capacity by considering alternate formats to present information in, such as pictures, sign language, considering meeting locations and times
Describe the principle ‘Unwise decision can’t be seen as wrong decision’ of Mental Capacity Act 2005?
Clinician must respect individuals choices and views even if they disagree
If an individual suddenly makes an ‘unwise’ decision according to the clinician, why could this warrant further investigation?
Can indicate that individual is being coerced into making that decision
Describe the principle ‘best interests at heart of decision making’ of Mental Capacity Act 2005?
If it has been proven that individual lacks capacity, all decisions/actions must be made in their best interest
Describe the principle ‘least restrictive intervention’ of Mental Capacity Act 2005?
All decisions must promote rights and freedom of the individual
What test is provided in the Mental Capacity Act 2005, that tests capacity?
Two stage test
Describe stage 1 of the two stage test for capacity?
Does the patient suffer from impairment/disturbance in function of the mind or brain?
Describe stage 2 of the two stage test for capacity?
Does the impairment/disturbance in function of brain or mind make the individual unable to make a decision at that time?
What test is used in stage 2 of the two stage test for capacity, and what 4 factors are questioned in this test?
Functional test determines whether patient is able:
To understand info relevant to the decision
To retain info
To use/weigh that info as part of the decision making process
To communicate their decision (by any means)
Does an individual with a mental illness still have capacity?
Yes
How can temporary factors affect an individual’s capacity, and list 4 temporary factors?
Temporary factors can temporarily make individual lack capacity, so any decisions made by clinicians must be sure that these factors rendered individual’s capacity absent before making decisions in their interest
eg. Shock, drugs, needle phobia, pain
How can encouraging patient participation and exploring their views in consultations allow clinicians to act in their best interest, in 2 ways?
Clinician can avoid assumptions/discrimination
Clinician will know how to act in all relevant circumstances
What 2 questions should a clinician consider when making a decision to act in patient’s best interests, especially if it is a potentially fatal circumstance?
Will patient regain capacity
Is the decision for life-sustaining treatment
When deciding to act in a patient’s best interests, should the clinician make this decision alone?
No, they have a duty to consult peers, and gain a second opinion
Can also consult ethics committee
Why should a court declaration be obtained when acting in a patient’s best interests?
states whether patient had capacity or not, and if the decision in their best interests was lawful
When a decision is made in the patient’s best interests, what 4 pieces of info must be documented?
How the decision about best interests was reached
What the reasons for reaching the decision were
Who was consulted
What particular factors were taken into account
What is a material risk?
Risk that a reasonable person in the patient’s position would attach significance to, or that doctor knows a patient would attach significance to
What 3 factors should be considered by clinicians when determining if a treatment has material risk to a patient?
Consider effect of treatment on patient
Consider importance of benefits of/desire to have the treatment to patient
Consider alternative treatments and their risks
What is the doctor’s role regarding material risks of treatments?
To advise patient through comprehensible means about any material risks of any treatments and their alternatives, so that they can give informed consent
Give an example of material risks in practice?
Very rare but severe side effects that patient would like to be aware of before consenting to start treatment
Give 3 examples of material risks of surgery?
Sequela
Failure to cure
Complications
What is a sequela in surgery, and why are they material risks?
Aftereffect of surgery that is inherent (inevitable) to the procedure
Patient will definitely experience it, so they should be informed about it
What is meant by ‘failure to cure’ in surgery, and why is it a material risk?
surgery executed without complications but original objective of surgery not achieved
Patient should be prepared for this difficult outcome instead of becoming absolutely sure that the surgery will cure them, as this is dishonest
What are complications in surgery, and why are they material risks?
Unsavoury, unanticipated, secondary or additional disease
Will make recovery harder, so patient should be aware of them
Are medical students allowed to obtain valid consent for a procedure?
No
Who’s responsibility is it to obtain valid consent from a patient for a procedure?
The doctor performing the procedure, unless they delegate the responsibility to another MDT member competent to complete the procedure
What 4 skills must the MDT member obtaining valid consent have?
Sufficient knowledge of risks and benefits of the treatment
Communication skills
Competent to perform treatment themselves
Suitably trained
If the responsibility of obtaining consent from a patient is delegated inappropriately, is the consent valid?
No, this invalidates the consent, and so if the procedure is performed this constitutes medical battery as the patient hasn’t given valid consent
For what type of procedure is non-verbal consent valid?
Quick, minimally-invasive procedure
What 3 things must a clinician do if they perform a quick, minimally-invasive procedure with non-verbal consent?
Explain to patient what they are doing and why
Clearly explain to patient that they can stop procedure at any time
Be alert during explanations and procedure itself of patient’s happiness/confusion
Why is it important to take listen to a child patient’s decisions, choices when obtaining consent on behalf of that child patient?
Children have rights that must be respected and doctor should always act in the child’s best interests
Why can it be difficult to identify what a child patient’s best interests are?
They might not completely understand treatment details and so won’t have capacity
When can a child consent to their own treatment?
If they have capacity and are Gillick competent
When a child lacks capacity, who has right to act in the child’s best interests and give valid consent for the child’s treatment?
Parents/legal guardians of the child
Court
If the parent/legal guardian of the child patient won’t act in child’s best interests, how can the medical team of the child patient prevent this from progressing?
Medical team can apply for court order, should also involve hospital legal team and Safeguarding Children lead
In which situation can you provide treatment without any consent on the child patient’s behalf?
Emergency situation to save the child’s life
Can children ages 16 and 17 give valid consent for their own treatment?
Yes, as it is legally presumed that when a child turns 16 they have capacity to make decisions about their own care
What does the Gillick competence state about parental rights compared to the child patient’s rights for making decisions about the child’s treatment?
Parental rights yield to the child’s right to make own decisions
What 2 qualities must a Gillick competent child patient have to make up their own mind regarding their treatment and give consent?
Sufficient intelligence and understanding to make informed decisions
If a child refuses treatment, which 2 bodies can override their refusal and give consent on the child’s behalf?
Persons with Parental Responsibility
Court
How are disputes about a child’s treatment settled, and what are the 2 possible outcomes?
Case is referred to court who either:
Impose inherent jurisdiction, which protects individual’s right to own decision making
Impose treatment in child’s best interests, overriding child’s refusal
What are the 3 types of consent?
Implied: patient is presenting to clinician to be examined, or can give permission non-verbally
Oral: verbal conversation gaining permission this is often formalised after encounter with documentation in the notes
Written: pre-emptive, involved, best supported in law
What are the 2 types of explicit consent?
Oral: verbal conversation gaining permission this is often formalised after encounter with documentation in the notes
Written: pre-emptive, involved, best supported in law
Should treatment options outside the UK also be discussed with the patient?
Yes, as this would constitute the patient being informed about all treatment options
What 4 qualities should a reasonable alternative treatment option have?
Must have known, established procedure
Must be accepted practice
Must be an appropriate option, not a possible option.
Not a variant of current Treatment
Give 3 examples of situations in which a clinician can withhold info about a treatment from a patient?
Patient says that they don’t want to know the info
Necessary situation eg. emergency with unconscious patient
Knowing this info would be severely detrimental to patient’s health
In order to find out what info matters to a patient so that you can act in their best interests if needed, do you need to explain even small risks or procedure details?
Yes, must explain everything no matter how small the information
When you explain the treatment to a patient, how do you tailor the explanation to be patient-centred?
Prioritise risks according to what would affect that specific patient the most eg. a partially blind person would consider full-blindness an important risk
What 3 things do you need to ask the patient about to find out what treatment info is important to them?
Needs, wishes, priorities
How does a doctor determine what language and approach to use with each patient so that the info is delivered in a comprehensible way?
Determine the patient’s current level of knowledge and understanding of the treatment and risks
Does the nature of the patient’s condition affect the complexity of the treatment and level of risk, and should the patient be made aware of this?
Yes, the patient should be told this
When explaining a treatment to a patient, where are recognised risks from?
Royal Colleges
Can a clinician assume what info a patient would like to know about a treatment?
Never assume, should always give patient all info
If a treatment/investigation is complex or has significant risks, is written consent required?
Yes
If a treatment/investigation will have significant effects on a patient’s social, personal lives and employment, is written consent required?
Yes
If providing clinical care isn’t the purpose of treatment/investigation for a patient, do they need to sign a written consent form to proceed?
Yes
If the treatment of a patient is for a research programme, what kind of consent is required?
Written consent (explicit)
Give one example of a specific treatment that requires written consent?
Fertility treatment
What does the common law doctrine of necessity state about treating patients in emergency conditions without gaining consent first?
Not gaining consent is justified if the treatment is a necessity and the clinician does no more than is reasonably needed to treat the patient (they use least restrictive course of treatment)
When treating a patient in a situation where their consent wasn’t gained first, how can you prove that you acted in their best interests?
Document everything so that you can justify your reasoning for treating that patient eg. state that it was a life-threatening situation and patient was unconscious
What 2 steps does GMC para 62-64 guidelines provide on how to deal with emergency situation with unconscious patient?
Provide treatment that is immediately necessary to save patient’s life/prevent serious deterioration
Wait for patient to become conscious and regain capacity, then explain administered emergency treatment and discuss ongoing treatment
Give 3 examples of situations in which the Mental Health Act states that the patient should be treated, even if they are are competent but refusing treatment?
Patient has severe mental health issue
Patient has attempted suicide
Patient has attempted severe self-harm
How is a mentally-ill patient sectioned (kept in hospital in treatment) according to the Mental Health Act?
Social care worker or relative need to make an application, then 2 doctors are needed to section patient
If an individual is severely ill and living in unhygienic conditions, can they be taken to a place of care without their consent?
Yes
In situations where treatment s given without consent, what factor determines if this otherwise unlawful act is justified?
The imminence and severity of the threat that the patient is facing
How many consent forms are there, and what is each form for?
There are 4 standard consent forms
Form 1 - adults or children with mental capacity
Form 2 - parental consent to treatment/investigation of a child or YP
Form 3 – procedure specific consent form.
Form 4 - adults who lack mental capacity
Is it sufficient to obtain a signed consent form from a patient instead of discussing the treatment with the patient?
No, but a consent form is helpful in prompting the patient to share and ask for info, and is a standardised way to record decisions
Does the patient also keep a copy of the signed consent form?
Yes
List the 3 steps in the consent process for undergoing an operation?
New patient clinic (GP), where patient is given consent letter
Pre-operative assessment with written consent
Confirmation and re-checking of consent on day of procedure
