PVB L4

Question 1

Define constent

Answer 1

Patient’s agreement for a health professional to provide care

• Legal + ethical right
  (principle of autonomy - individuals have right to make decisions about their own body)
• Common courtesy
• Joint decision making
  (more than just siging a form - effective communication + inf sharing between healthcare provider + patient, ensures patient fully understands condition)

Question 2

Explain the purpose of consent

Answer 2

Clinical purpose - confidence, cooperation + agreement of patient contributes to sucessful treatment

Legal purpose - evidence that clinician has been given permission to intervene

Question 3

Describe the responsibility of the healthcare professional in gaining consent

Answer 3

• must make sure consent is given from patient before giving treatment
• if you have got a colleague to seek consent on your behalf, make sure you are confident the colleague is competent
• make sure you work within your competence and not agree to perform tasks that exceed your competence

Question 4

Give 2 factors determing if the person obtaining the consent is competent

Answer 4

1. Be capable of perfoming proceadure themselves
2. Hvae recieved specialist training in advising patients about the proceadure

Question 5

Describe what factors make consent valid

Answer 5

The patient must:
1. Be competent to take the decision

2. Have recieved sufficient info
3. Not be acting under duress (pressure)

Question 6

Give examples of situations where consent is needed

Answer 6

1. Before examination, treatment, care for competent adult patients
2. Doubting competence of patient (can patient weigh up the info needed to make decision?)

PATIENTS CAN CHANGE THEIR MINDS + WITHDRAW CONSENT ANY TIME

Question 7

How do patients give consent?

Answer 7

Written, oral, non-verbal

SIGNATURE ON CONSENT FORM DOES NOT ITSELF PROVE CONSENT IS VALID

(point of form is to record patient’s decision)

Question 8

Describe informed consent and under which circumstances it can be nullified

Answer 8

Consent remaining valid for an indefinite period - consent which is obtained in advance - patients express consent for future treatments

CIRCUMSTANCES
-patient’s condition has not changed
-no new info on alternative treatments - informed consent is based on providing patients with accurate + up to date info

IT IS GOOD PRACTICE TO CONFIRM CONSENT AT TIME OF TREATMENT ANYWAY, EVEN IF THE PATIENT HAS GIVEN INFORMED CONSENT (allows healthcare professionals to reiterate details of proceadure)

Question 9

Describe how the healthcare professional should explain the proceadure whilst obtaining consent from the patient

Answer 9

• brief explanation of treatment
  -what patient may experience (pain)
  -risks
  -avoid medical jargon
  -benefits
  -alternative treatments
  -risks / benefits of doing nothing
  -reitterate patient has right to refuse / withdraw treatment at any time

Question 10

How do deal with adults + children when obtaining capacity

Answer 10

18+ - presumed to have capacity, unless opposite demonstarted

16-17 - competent to give consent unless demonsrated otherwise

16 or below: Gillick capacity - sufficient understanding to enable him / her to understand what is proposed, then he/she will have capacity to give consent”

Question 11

What can a healthcare professional do to improve their practice when obtaining consent from patients aged 14-18?

Answer 11

GET PERSON WITH PARENTAL RESPONSIBILITY TO COUNTERSIGN

Question 12

Describe the tennets of Gillick capacity

Answer 12

Does the child have sufficient understanding to enable him / her to understand fully what is proposed?

NO SPECIFIC AGE AT WHICH A CHILD HAS CAPACITY TO CONSENT

EACH CHILD ASSESSED SEPARETLY IN RELATION TO EACH DIFFERENT PROCEADURE

A CHILD MAY BE ABLE TO CONSENT TO SOME PROCEADURES NOT OTHERS

TEST IS ABOUT CAPACITY, NOT ABILITY OF CHILD TO MAKE A CHOICE

At 16 years a person is regarded as competent to give consent unless there is evidence to the contrary.

Good practice to involve families of 16 and 17 year olds in the decision-making process unless the young person specifically requests that this
should not happen.

Attempts should be made to persuade them to confide in their families.

Attempts should be made to persuade them to confide in their families.

Question 13

Children who lack Gillick capapcity

Answer 13

1. If child under 16 and lacks Gillick’s competence, person with parental responsibility must give consent
2. Consent only needs to be given by one person with parental resonsibility
3. A person with parental responsibility can make decisins for some responsibility to be met by others
4. Authory given in writing

ALTERNATIVE SETTINGS

• Residential setting (therefore, complex care needs), joint care plan drafted by parents + carers

Question 14

People who lack capacity to consent

Answer 14

1. Person can be 18 or over + deemded not legally competent to give consent

Question 15

Outline the circumstances in which a perosn is not legally competent to give consent

Answer 15

1. If they are unable to comprehend, retain info, to make decision + unable to use info in coming to decision

Question 16

True or False:

Relatives cannot be asked to sign this form on behalf of an adult who is not legally competent to consent for himself or herself

Answer 16

True

Question 17

Outline people who have parental responsibility

Answer 17

1. Child’s parents if they were married at time of birth
2. Child’s mother if not married as above, unless dather has aquired parental responsibility through court order
3. Child’s legal guardian
4. Person who court has made a residence order relating to child
5. Local authority designated to care for child
6. Local authority or other person who holds emergency proyecyion in respect of child

Question 18

Describe the assesment of a patient’s capacity in accordance with MCA

Answer 18

A patient will deemed to lack capacity if thet cannot do one or more of the following:

Understand info given

Retain info for long enough period to make decision

Weight up the info, positives, negatives

Communicate - verbally, in writing

Question 19

Outline the key principles of the MCA

Answer 19

1. Presumption of capacity
   above 18, assume all patients have capacity
2. Support individuals ot make their own decisions
   even if they lack capacity, involve patient as much as you can
3. Unwise decisions
   just because one person thinks its unwise, does not mean they do not have capacity, people have different values
4. Always act in best interest of patients
5. Less restrictive options - when making decision on behalf of patient, try interfere less with person’s rights

Question 20

Outline the basis of refual of treatment in lines with the MCA

Answer 20

Competent adult patients are:
-entitled to refuse treatment, even if it would clearly benefit health
-except in circumstances covered in MCA (2005)

Followinf the refusal:

-Refusal should be clearly documented in notes
-if patient has given consent, then changes mind, you and patient (if they can) must document this
-doctor must provide appropriate care to which the patient has consented

EXCEPTION: young person, 16, 17, <16 but Gillick’s competent, refuses treatment, this refusal can be disregarded if probability of them not taking treatment can lead to death / severe permenant injury