Treatment in the Emergency Department

Question 1

What does the GMC state about treating patients in the emergency department without gaining consent?

Answer 1

(Necessity) “When an emergency arises in a clinical setting and it is not possible to find out a patient’s wishes, you can treat them without their consent, provided the treatment is immediately necessary to save their life or to prevent a serious deterioration of their condition. The treatment you provide must be the least restrictive of the patient’s future choices.”

Question 2

What does the Mental Capacity Act state about treating patients who do not have capacity?

Answer 2

An act done, or decision made under the Mental Capacity Act for, or on behalf of, a person who lacks capacity must be made in their best interests.

Question 3

What must be considered when determining the best interests of somebody who lacks capacity?

Answer 3

• The person’s past and present feelings and wishes (and any written statement from when they had capacity)
• The beliefs and values likely to influence their decision if they had capacity
• Other factors they would be likely to consider if they had capacity

Best interests decisions must not be made based on:

• A person’s age/appearance
• A person’s condition or aspects of their behaviour which may lead to injustified assumptions of their best interests.

Question 4

When can restraint be used?

Answer 4

If there is reasonable belief that restraint is necessary to prevent harm to the patient or others.

• Restraint must be a proportionate response to:
  
  • The likelihood of the patient’s suffering harm and
  • The seriousness of that harm

Question 5

Who can provide consent for a person under the age of 18?

Answer 5

• The child if competent
• Mother
• Father if:
  
  • Married to the mother at the time of the child’s birth OR
  • Name on the child’s birth certificate
  • By parental responsibility agreement with the mother
  • Various kinds of court order

Question 6

Which legal framework applies to treating patients in an emergency situation who cannot give their consent?

Answer 6

Common Law Doctrine of Necessity

Question 7

Which legal framework applies to treating patients who lack capacity?

Answer 7

The Mental Capacity Act

Question 8

Define restraint

Answer 8

A doctor restrains a patient if they:

a) use or threaten to use force to secure the doing of an act which the patient resists OR
b) restricts the patient’s liberty of movement, whether or not the patient resists.