Professional ethics as a pharmacist 2: Consent for the provision of services Flashcards
Consent:
• Definition: to express willingness, give permission or agree • Purpose of consent to treatment – moral purpose – clinical purpose – legal purpose – Professional purpose
Valid consent:
– have the capacity to give consent for this decision
– acting voluntarily
– have sufficient, balanced information to allow them to make an informed decision,
– capable of using and weighing up the information provided
• Ongoing process
• Can be withdrawn at any time
• Responsibility of pharmacy professional to ensure person has given valid consent
Consent – form of consent?
Validity of consent does not depend on form in which it is given
• Explicit consent
– Written consent
• Evidence of consent if it was valid
• If invalid, signature does not make it so
• Good practice for ‘significant procedure’
– Verbal consent
• Illiteracy
• Inability to give written consent
• Implied consent
– Holds out arm for blood pressure to be taken
A person lacks capacity if:
– at the time the decision needs to be made,
– they are unable to make or communicate the decision
– because of an impairment or disturbance that affects the way their mind or brain works.
Assessing Capacity:
• A person making an informed decision should be able to:
– understand information provided
– retain and believe it
– weigh it in the balance to make a choice
– communicate the decision
• Take all reasonable steps to help & support people to make or be involved in decisions
• “No decision about me, without me”
• Adults
– assume capacity unless enough evidence to suggest otherwise
• Young people (16 & 17 years)
– assume capacity unless enough evidence to suggest otherwise
• Children
– must demonstrate their capacity to make each decision
What is “Sufficient information”?
– Civil law about battery
• patient informed in broad terms
• nature and purpose of treatment explained
• consent ‘real’ and no liability in battery
– Civil law about negligence
• higher standard operates for negligence
• ‘material’ or ‘significant risks’ must be disclosed
• sufficiency of information defined by Bolam principle
• patient’s questions answered truthfully - (subject to therapeutic privilege)
Mental capacity act 2005:
• England & Wales only, (similar to Adults with Incapacity (Scotland) Act 2000) • Applies to individuals over 16 years • Five key principles – A presumption of capacity – Individuals being supported to make their own decisions – Unwise decisions – Best interests - Least restrictive option
Consent: Best Interests:
- A person with lasting powers of attorney can consent to treatment on behalf of an incompetent adult
- doctrine of necessity can be invoked for emergency treatment
- treatment can be given on basis of best interests
Best interests – Mental Capacity Act:
- “Not make assumptions on the basis of age, appearance, condition or behaviour.
- Consider all the relevant circumstances.
- Consider whether or when the person will have capacity to make the decision.
- Support the person’s participation in any acts or decisions made for them.
- Not make a decision about life-sustaining treatment “motivated by a desire to bring about his (or her) death”.
- Consider the person’s expressed wishes and feelings, beliefs and values.
- Take into account the views of others with an interest in the person’s welfare, their carers and those appointed to act on their behalf.”
Emergencies.
Provide treatment in patient’s best interest
• Doctrine of necessity:
– interventions to be made which are necessary
– no more than is reasonably required
– Pending recovery of capacity
• Applies to adults, young people and children
Consent: Involvement of the Court of Protection
• Where the patient lacks capacity, referral to court may be necessary for a ruling on lawfulness of a procedure, before a procedure is undertaken
• These include (but are not limited to):
sterilisation for contraceptive purposes
– donation of regenerative tissue such as bone marrow
– withdrawal of nutrition and hydration from an individual in a persistent vegetative state
where there is doubt as to the individual’s capacity or best interests.
Consent: Children and Young People:
- Children - Under age of 16
- Young people – 16 or 17
- Consent – who can consent?
- Child or young person
- parent or guardian
- Court
• Young people are presumed to have capacity unless evidence otherwise. Children not presumed to have capacity but must demonstrate it
‘Gillick Competent’ is:
– no specific age – depends on individual child
– “… child capable of understanding and who has the intelligence to understand fully what is proposed” Lord Scarman
– parent can act for a child who is not ‘Gillick Competent’ but cannot override a ‘Gillick Competent’ child’s consent
Gillick competence’ depends on:
seriousness of the decision taken as well as cognitive powers and maturity.
• Parents, guardian or court able to over-rule refusal by a ‘Gillick competent’ adolescent to receive treatment which is in his/her best interests
Children: Consent by Others
• Rationale for distinguishing between consent and refusal
– consent – accepting greater knowledge of medical profession
– refusal – decision asks more of the child
– Courts reluctant to empower children to refuse treatment against medical opinion; best interest test applied
