Medical Law Flashcards
What are the markers to assess competence
Need to be competent to give valid consent
-Understand information
-Retain information
-Use information
- Communicate decision.
What are the exceptions to gaining explicit consent
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).
What is an LPA
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.
What is a Independent Mental Capacity Advocate (IMCA)
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.
Do Advanced Decisions take precedence over LPAs?
Yes, unless LPA was appointed after AD was made
Can advanced decisions request treatment, and do best interests apply?
Best interests do not apply. ADs can only refuse treatment, not request it.
What is the one exception to advanced decision making
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.
What 3 things can AD not refuse
basic nursing care, hydration and oral feeding.
What makes an AD invalid
Competent withdrawal
LPA appointed after AD was written
Patient acted in way that is inconsistent with AD (suggesting they have changed their mind)
When is an AD inapplicable
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).
What circumstances does an AD refusing life sustaining treatment need to be under (can’t just be verbally)
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)
Can an AD be withdrawn by the patient, and if so under what circumstances
Withdrawal of AD can be oral and withdrawn at any time provided patient is still competent.
Once patient loses competence, AD cannon be withdrawn.
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
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.
How do you assess for Gillick Competence
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.
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
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.
What do you do when a child refuses life saving treatment
What if they are 16-17
- 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.
What are the 4 scenarios where disclosures required by statute do not require consent
Notification of death (death certificate)
Notification of termination
Treatment of drug addicts with specific drugs
Notifiable infectious diseases.
What are the conditions in which to disclose information to the police
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.
What is the laws for breaking confidentiality with children
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.
Do relatives have a right to know about the patient
Relatives do not have a right to know about the patient unless they are the parent of a child who is not Gillick competent.
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
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).
Can parents refuse life saving treatments for their children
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.
Is Murder or intent to murder a justifiable breach of confidentiality.
Yes
If someone has a temporary lack of capacity, when should a decision regarding treatment be made
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).
