Laws

Question 1

What does consent require?

Answer 1

1. Patient must have CAPACITY to consent to intervention
2. Patient must be appropriately INFORMED
3. Must be given VOLUNTARILY - not under influence

Question 2

Mental Capacity Act

Answer 2

1. Presumption of capacity for adults aged 16 and over
2. Person not to be treated as unable to make decision unless “all practicable steps to help him to do so have been taken without success”
3. Right to make eccentric or unwise decisions
4. All actions/decision under the Act for/on behalf of the person must be done or made in their BEST INTEREST
5. Actions/decisions must be those that are least restrictive of basic rights and freedoms

Question 3

Does the patient have capacity?

Answer 3

1. Is the patient suffering from an impairment of, or a disturbance in the functioning of, the mind or brain?
2. Does the disturbance/impairment make a person UNABLE to make a decision for himself, at the time?
   Are they unable to:
   a) understand information relevant to the decision
   b) retain information
   c) use or weigh up that info as part of a decision process
   d) communicate their decision (by any means(

Question 4

Re B

Answer 4

Adult refusal of treatment (life-prolonging)

Question 5

Re C

Answer 5

Adult refusal of treatment - mental illness does not automatically mean they do not have capacity

Question 6

Re MB

Answer 6

Patients may become temporarily incapable of making a decision

Question 7

Montgomery

Answer 7

All risks should be weighed up and explained to an individual (side effects, small risks)

Question 8

Gillick

Answer 8

Children <16 can consent to contraceptive treatment without parents if they have sufficient understanding/intelligence to weigh up risks

Question 9

Fraser Guidelines

Answer 9

1. <16 girl will understand advice
2. Cannot persuade her to inform her to inform her parents
3. Very likely to continue to have intercourse w/o treatment
4. Without treatment/advice her physical/mental health is likely to suffer

Question 10

Stephens v Avery

Answer 10

Confidential information cannot be disclosed

Question 11

Bolam

Answer 11

Actions would have been followed by a reasonable body of medical men

Question 12

Bolitho

Answer 12

Even if medical experts agree, a judge can overrule the decision if the opinion cannot withstand logical analysis

Question 13

Wilsher

Answer 13

The trainee/learner is to be judged by the same standards as their more experienced colleagues. If other risks/factors could have caused the injury, then on the balance of probabilities the hospital was not liable as it was more likely that an alternate risk had caused the injury (blindness to baby)

Question 14

‘But for’ test

Answer 14

To establish causation.
“But for” the negligence, would the harm still have occurred?
Balance of probabilities is used

Question 15

Negligence

Answer 15

1. They were owed a duty of care
2. That duty of care was breached
3. They have sustained an injury
4. Which was caused by that breach of duty

Question 16

Doctrine of necessity

Answer 16

Treatment is given without consent in emergencies

Question 17

Power of attorney: Ordinary

Answer 17

Person makes decisions on financial affairs even when you have capacity (pt away on holiday or in hospital)

Question 18

Power of attorney: Lasting

Answer 18

Covers decisions on financial affairs as well as health and care when capacity is lost or individual no longer wants to make decisions themselves

Question 19

Power of attorney: Enduring

Answer 19

Has been replaced by LPA

Question 20

When would you report to the coroner?

Answer 20

1. Unknown cause of death
2. Unnatural death e.g. murder
3. Suspicious circumstances or history of violence
4. Accidental or suicide
5. Neglect is suspected
6. Industrial disease is suspected
7. Not seen by a doctor in the last 14 days
8. During/shortly after detention by police/prison
9. Under the Mental Health Act
10. Within 24hours of hospital admission
11. Could be linked to a medical procedure/surgery

Question 21

Burke

Answer 21

Right to demand treatment even if doctors decide it is futile (advance directive)

Question 22

Confidentiality can only be breached if

Answer 22

1. Patient has given consent
2. If disclosure is in the patient’s best interests
3. To other members of the healthcare team
4. It is required by law (statute or court proceedings)
5. It is in the public’s best interest

Question 23

Bland

Answer 23

Withdrawal of artificial nutrition due to Bland being in a vegetative state

Question 24

Cox

Answer 24

Dr Cox was charged with attempted murder for injecting a terminally ill patient with PCl

Question 25

Pretty

Answer 25

A terminally ill mother wanted help to die, but could not carry out the process alone so her request was denied.

Question 26

Mrs B

Answer 26

Paralysed and put on a ventilator, but was competent so was able to have the ventilator turned off

Question 27

Re: T adult refusal 1992

Answer 27

Right to withdraw and refuse medical treatment (Jehovah’s witness refused blood)

Question 28

DNAR

Answer 28

Document signed by a doctor, only relates to CPR, legally binding

Question 29

Advanced decision

Answer 29

Written and legally binding. Made when a patient has capacity to refuse future life-saving treatment when they lack capacity –> can’t demand treatment

Question 30

Advanced statement

Answer 30

Can be written or verbal, not legally binding. This is made when a patient has capacity, but is only a request