Consent In Emergency Situations

Question 1

What is the legal framework that underpins treatment without consent?

Answer 1

Doctrine of Necessity
Principle of Best Interests
Mental Health Act (Detention)

Question 2

How does the Doctrine of Necessity relate to treatment without consent?

Answer 2

Comes into action if there is no time to assess capacity/consent, or if the situation is life-threatening

Question 3

How does the Principle of Best Interests apply to treatment without consent?

Answer 3

Applies when the patient lacks capacity

Question 4

When does detention under the Mental Health Act apply?

Answer 4

Applies regardless of Capacity in very specific conditions:
Proportionate and Minimum necessary restraint
Treatment is in best interests AND prevents harm

Question 5

How is the ethical framework different in emergencies from normal situations?

Answer 5

It isn’t, but it is more challenging to apply

Question 6

What must be considered when treating children in ED?

Answer 6

Doctrine of Necessity
Competent child’s consent
Parental consent
Shared parental responsibility (e.g. Teachers acting in loco parentis)

Question 7

What second line considerations must be taken in Emergency Situations?

Answer 7

Valid Advance Refusal of Treatment
Fair allocation of resources
Organ donation
Disclosure (police, family, social services)

Question 8

What is the legal framework for consent in emergencies?

Answer 8

Must facilitate patient’s capacity if possible

If not, seek proxy consent (if no capacity) - e.g. Legal Power of Attorney

Question 9

How can capacity be ‘facilitated’ in emergencies?

Answer 9

Pain relief
Timing
Support