Medical Law

Question 1

What are the markers to assess competence

Answer 1

Need to be competent to give valid consent
-Understand information
-Retain information
-Use information
- Communicate decision.

Question 1

What are the exceptions to gaining explicit consent

Answer 1

Emergency (no time, hence act in patients best interests)
Implied (through patient’s actions)
Waiver (patient doesn’t want to hear details, just start treatment)
Best interests (if not possible to gain consent or patient lacks capacity, doctor acts in best interests of patient).

Question 2

What is an LPA

Answer 2

Lasting Power of Attorney (LPA) → any adult can appoint someone to make decisions for them for when they lose capacity, provided they have capacity when they were appointed

Registered with court of protection.

LPA involved in final decision-making, personal decision-making, welfare decision-making including consent to treatment, refusal of life-sustaining treatment.

All decisions made by LPA must be in the best interests of the patient and can be contested. Can only make decisions once patient has lost capacity.

Question 3

What is a Independent Mental Capacity Advocate (IMCA)

Answer 3

If person lacking capacity has no one to support them( family members, next of kin), IMCA should be appointed.

Involved in decisions relating to serious medical treatment (unless urgent), proposals to move a patient into long-term care, plans to move a patient into a different hospital/care home.

Should attempt to ascertain patient’s beliefs, feelings and values and advocate on their behalf.

Question 4

Do Advanced Decisions take precedence over LPAs?

Answer 4

Yes, unless LPA was appointed after AD was made

Question 5

Can advanced decisions request treatment, and do best interests apply?

Answer 5

Best interests do not apply. ADs can only refuse treatment, not request it.

Question 6

What is the one exception to advanced decision making

Answer 6

Only exception = cannot make an advance decision to refuse treatment under the mental health act.

Mental Health Act 1983 → advance directives can be overridden if the patient is subject to compulsory treatment under the MHA 1983. Treatments for mental health disorders cannot be refused by an advance directive.

Question 7

What 3 things can AD not refuse

Answer 7

basic nursing care, hydration and oral feeding.

Question 8

What makes an AD invalid

Answer 8

Competent withdrawal
LPA appointed after AD was written
Patient acted in way that is inconsistent with AD (suggesting they have changed their mind)

Question 9

When is an AD inapplicable

Answer 9

significant change in circumstance not addressed previously (eg. pregnancy or remarrying)

significant change in prognosis/treatment of condition since AD made (eg. AD long time ago and new treatments available).

Question 10

What circumstances does an AD refusing life sustaining treatment need to be under (can’t just be verbally)

Answer 10

be signed and in writing
be witnessed and signed by witness
Specifically stated decision has to be respected even if life at risk.
(Other advance decisions may be made verbally, except life sustaining treatment)

Question 11

Can an AD be withdrawn by the patient, and if so under what circumstances

Answer 11

Withdrawal of AD can be oral and withdrawn at any time provided patient is still competent.
Once patient loses competence, AD cannon be withdrawn.

Question 12

Consent to treatment for children
- what is the age to consent
- how many parents do you need to agree to a procedure
- what happens when both parents disgaree
- what happens in an emergency

Answer 12

16 is age of consent to medical treatment (parental responsibility ends at 18).

For children <16, if more than one person with parental responsibility, only consent from one is necessary.

If parental disagreement, a court order is recommended.

In emergency, with no parental responsibility to consult, treatment can be given without consent if in best interests of patients.

Question 13

How do you assess for Gillick Competence

Answer 13

Ask patient whether you can tell parents,

If yes then the child can be treated like any other child with parental permission

If no then confidentiality must be respected.

Assess how mature child is, do they understand treatment and complications?

If these criteria fulfilled and patient is likely to suffer physical or mental harm without treatment they can be considered Gillick Competent.

Question 13

Gillick Competence
- what is Gillick Competence for
- can treatment be refused
- how does this differ for 18+ year olds
- is there a lower age limit to Gillick competence

Answer 13

Assess competence of a child <16yrs so under certain circumstances, a doctor can obtain permission to treat a child without consulting a parent.

Allows minors to accept treatment, but they cannot decline treatment that is in their best interest (unlike >18s who can refuse life saving treatment).

No lower age limit to gillick competence.

Question 14

What do you do when a child refuses life saving treatment

What if they are 16-17

Answer 14

• If child is refusing treatment, ask parents for consent, and then ask the court.
• If 16 or 17, if child refuses treatment, can still be given with court order.

Question 15

What are the 4 scenarios where disclosures required by statute do not require consent

Answer 15

Notification of death (death certificate)
Notification of termination
Treatment of drug addicts with specific drugs
Notifiable infectious diseases.

Question 16

What are the conditions in which to disclose information to the police

Answer 16

Under warrant from circuit judge
To aid police request to identify drivers suspected of road traffic offences
To aid police in all matters regarding terrorism.

Question 17

What is the laws for breaking confidentiality with children

Answer 17

In Children → if <16 AND not Gillick competence confidentiality can be breached if it is thought to be in the best interests of the child.

If Child is Gillick competent OR >16 they can refuse consent to disclosure, but this can still be lawfully breached if it is in the child’s best interest.

Question 18

Do relatives have a right to know about the patient

Answer 18

Relatives do not have a right to know about the patient unless they are the parent of a child who is not Gillick competent.

Question 19

Breaking confidentiality:
- What are the three BROAD situations where confidentiality can be breached
- how much information can you give
- do you inform the patient when you are about to break it

Answer 19

Always maintained unless
- Consent given by patient
- Required by law
- it is in the wider public interest.

When required to breach, give the minimum amount of information necessary. Good to inform patient when you have to breach confidentiality (unless it defies objective of breaching confidentiality).

Question 20

Can parents refuse life saving treatments for their children

Answer 20

Parent can never refuse treatment for child, even on religious grounds
(if both refuse still give treatment on basis of best interests). Only need consent from one parent to go ahead.

Question 21

Is Murder or intent to murder a justifiable breach of confidentiality.

Answer 21

Yes

Question 22

If someone has a temporary lack of capacity, when should a decision regarding treatment be made

Answer 22

If person has temporary lack of capacity (ie. patient under general anaesthetic in surgery and incidental finding found) ⇒ should defer decision until patient has capacity (unless issue poses imminent threat to life).