Ethics

Question 1

Rules for LPA

Answer 1

Must be done with capacity + with court

Extent of decision making must be specified in the LPA:

• Financial decision making.
• Personal decision making.
• Welfare decision making including consent to treatment.
• Refusal of life sustaining treatment.

The donee’s decisions must be in the person’s best interests. ONLY DECISIONS IF BEST INTEREST
The donee of the LPA can only make decisions when the donor has lost capacity.

Question 2

Court of protection use

Answer 2

Certain medical decisions should go before the Court of Protection for a determination of best interests:

Withholding or withdrawal of artificial nutrition from patients with persistent vegetative states.
Organ donation or bone marrow transplants.
Sterilisation for non therapeutic purposes, e.g. contraception.
Some termination of pregnancy.
Major decisions where there is doubt or dispute about best interests

Question 3

Exceptions to consent

Answer 3

Emergency
Best interest (if not possible to obtain consent)
Waiver
Implied

Question 4

What is a competent person

Answer 4

Understand the information.
Retain the information.
Use the information to make a decision.
Communicate the decision.

DECISION SPECIFIC

Question 5

Presumption of competence

Answer 5

Adults (from age 16 onwards)
Are assumed to have mental capacity to make a decision regarding treatment.
Unless there is contrary evidence.

Children (less that 16)
Are assumed to NOT have mental capacity to make a decision regarding treatment.
Unless there is contrary evidence.

he legal situation regarding individuals aged under 18 but 16 or older is slightly more complicated, particularly regarding refusal of treatment. Please see the Children and the Law e-module for a detailed explanation.

Question 6

Non-therapeutic medical interventions in children research rules

Answer 6

Research on children should only be carried out when:
it carries minimal risk of harm.
it is not possible to carry out the research in adults.
the condition being studied is specific to young children.
parental consent is obtained.

Question 7

Age of consent

Answer 7

Age of consent to medical treatment is 16.

For patients below 16 only those who have parental responsibility can agree to medical treatment for the child.

Although Parental Responsibility ends at 18, some of the powers of being able to agree to medical treatment on behalf of a child end at the child’s 16th birthday.
If there are several people with parental responsibility then it is acceptable to gain permission from only one of them.
For major decisions where there is parental disagreement it is advisable to seek court approval
Gillick exception