Treatment in ED Flashcards
What is required for consent to be valid?
1) capacity
2) information
3) voluntariness (freedom from coercion).
what is the legal framework surrounding consent?
Consent should be app. to the situation. Need to consider level of information needed/ possible and how or whether to facilitate capacity (e.g. pain relief, environment, support).
If a patient lacks capacity what other forms of consent could we acquire?
1) lasting power of attorney - appointed by patient in advance
2) court - appointed deputy (appointed when the patient lacks capacity).
What is the problem with consent in the ED?
Due to lack of time to make decision and immediate risk to life, patient may lack capacity to make decision –> therefore difficult to respect autonomy which is required in consent.
Part of autonomy is respecting the need for consent.
In the ED situations arise where patient lacks ability to consent –> need to still respect the autonomy of patient who cannot consent.
What is the legal framework for treating without consent?
1) Doctrine of necessity (common law) –> urgency - emergencies may be life threatening and may mean reduced time for assessing capacity.
2) If a patient lacks capacity, treatment must be in their best interests (MCA).
3) patient can be detained under the MHA - whether or not they have capacity, but only under very specific conditions.
What is necessity in treating in the ED?
What should treatment be?
Necessity describes a situation where it is not possible to find out the patients wishes and they need to be treated without their consent either to save their life or prevent serious deterioration.
Treatment should be least restrictive of patients future choices.
what 4 things are required for a patients to be considered to have capacity? ( in the mental capacity act)
In order for a patient to be deemed to have capacity they need to be able to do ALL of the following:
1) understand the information necessary to make a decision
2) retain the info long enough to make a decision
3) weight the information
4) communicate their decision
What must be done if treating a patient without capacity?
The act/ decision made on behalf of the patient under the mental capacity act must be done/ made in their best interests.
What factors are considered when deciding what is in someone’s best interests?
1) the person’s past and present wishes/ feelings - in particular any written statement made by them when they had capacity.
2) the beliefs and values that would be likely to influence their decision if they had capacity
3) other factors they would likely to consider if they were able to do so.
What factors should not be considered when deciding what is in someone’s best interests?
1) the person’s age or appearance
2) a condition or aspect of their behaviour which might lead others to make unjustified assumptions about what might be in their best interests
What is restraint?
When can it be used?
Restraint is when someone uses or threatens to use, force to secure the doing of an act which the P resists or restricts P’s liberty of movement, whether or not the p resists.
It can be used when the Doctor reasonably believes it is necessary to do the act in order to prevent harm to the patient. The second is that the act is proportionate response to 1) the likelihood of P’s suffering harm 2) the seriousness of that harm.
When it comes to treating children who should we seek consent from first?
1) the child themselves - if they are Gillick competent
2) the parents - parental responsibility (under the children act 1989) is with:
- mother
- father if married to mother at time of child’s birth or if registered on the birth certificate
- by parental responsibility agreement with the mother
- or by various kinds of court order
Summarise the key factors that need to be considered when treating adults in the ED
1) Consent where possible / appropriate:
- Assess facilitate capacity
- Respect competent refusal
- Respect advance refusal
- Consider proxy consent
2) Doctrine of necessity
3) Best interests - use checklist from MCA
4) Mental health act - if specific conditions are met
What are other important issues to consider (apart from the key ones) that should be considered in ED?
1) Disclosure of information:
- To family
- To police
- To social services
2) Organ donation - donation after circulatory death
3) Resource allocation - how much resource should you allow for people that are going to be highly expensive to treat?
