w2: Ethics informed consent

Question 1

What is meant by the test of materiality?

Answer 1

Identifying what pieces of information the patient is likely to attach significance to.

Question 2

What are the different types of consent?

Answer 2

Expressed concent - singing a concent form and/or verbal yes
Implied content - verbal or action such a putting their arm out for a blood pressure cuff.

Question 3

What must a practitioner always ensure related to any form of consent?

Answer 3

The patient has been provided with the full clinical explanation and information.
The patient has been given the clinical option to refuse informed consent.
Any behavioural sign that the patient is unsure or unhappy about giving consent must be acted on immediately.

Question 4

What should a doctor do if a patient demands a treatment that they do not agree with clinically?

Answer 4

They do not need to give this treatment to the patient.
They should explore the reasons why the patient want this treatment, why it is not possible and offer an alternative treatment plan.
They should refer the patient for a second opinion.

Question 5

What patient based factors influence the giving of consent and the level of consent required?

Answer 5

-Health status of patient (emergency etc)
-Patients capacity to give consent
- Patients expressed wishes and personal priorities
-Patients knowledge and understanding
-Complexity of the treatment and possible complications
- Nature of risk.

Question 6

What should the practitioner do if the patient does not wish to be told any information about the treatment but needs to give informed consent?

Answer 6

The information must be given to the level that is reasonably practicable.
This means it is appropriate to the nature of the medical treatment and the level of risk.
A record should be kept of what information was given to the patient and that they wished not to have any information shared with them (legal defence).

Question 7

What additional clinical resources can be used in assisting a patient in giving informed consent?

Answer 7

Other healthcare professionals in the care team
Patient information leaflets
Patient Advocacy services
Expert Patient Programmes - often for chronic conditions
Patient Support Groups

Question 8

What are the criteria of a medical practitioner that makes them able to take informed consent?

Answer 8

Should often be the member incharge of that element of care
Should be suitably trained and qualified
Should have sufficient medical and clinical knowledge
Fully understand the potential clinical hazards and side effects
Should understand the approved clinical practice.

Question 9

What are different types of clinical hazards?

Answer 9

Clinical side effects
Medical complications
Failure of investigation, examination or treatment probability.

Question 10

What is meant by consent as a continuous clinical process?

Answer 10

Consent must be taken from the patient again if a large time span has elapsed before treatment starts.
The patient is able to change their mind and withdraw their.
Consent should be taken again if clinical information and risk changes, the patient must be updates with these new changes.

Question 11

In regards to informed consent what should be recorded in the patient notes?

Answer 11

When consent was given, what is was given for, implies or expressed, if a consent form was used it should be in the notes, and contextual details about what information was shared with the patient.

Question 12

In what conditions is expressed consent not needed?

Answer 12

The patient is detained under the mental health act.
The patient is in an emergency situation and treatment will save their life.
The patient is in serious distress or pain.
In this case implied consent or generally accepted clinical judgement would be allowed.

Question 13

What is meant by reasonably forseeable changes the doctor should make to ensure the patient has the mental capacity when giving consent?

Answer 13

Discuss treatment when the patient is mentally competent e.g not on strong pain medication
Uses tools such as take away fact sheets to improve the patients memory and recall
Liase with the clinical team and family members subject to patient confidentiality.

Question 14

Who should be involved in deciding if a patient is mentally competent?

Answer 14

Practitioner incharge of care and the wider clinical care team.
Legal services team and Trust solicitors particularly is the patient is going to be detained/treated against their will.

Question 15

What considerations must still be made to treatment even if a patient is deemed as mentally incompetent?

Answer 15

Prioritise the patients best wishes
Respect the patient as an individual
Encourage the patient to engage with clinical decision making anyway
Protect the patient from any forms of discrimination.
Check is the patients has any existing records of decisions from when they were deemed clinically competent such as a power of attorney.
Treatment options should be least restrictive on the patients wishes
Is the patient always going to be clinically incompetent or does it vary?

Question 16

What is the legal link with consent?

Answer 16

Based on the ethical principle of Personal Autonomy,
Schloendorff v Society of New York Hospital court declared that an adult of sound mind has the right to give consent.

Question 17

What is the Tort of Battery?

Answer 17

Is a common law of informed consent.
Is a legal claim pursued by a patient, where the doctor has failed to gain informed consent such as not warning about a potential complication, not telling necessary qualifications or carrying out unnecessary procedures.
*Clinical harm is not needed to start this claim, but it is more common.
The patient can use the Tort of Battery to claim they have been assualted.

Question 18

How are attitudes towards doctor patient issues changing in the UK?

Answer 18

Shifted from a practitioner-centered approach to a patient centred approach, to the practitioner is responsible for checking the patients capacity, level of consent and level of understanding.

Question 19

What is the Bolam Principle?

Answer 19

Determines the minimum level of care that must be given to the patient, before the practitioner is accused of medical negligence.
A practitioner is not negligent if he gives the minimum level of care deemed necessary by other medical professionals.

Question 20

What is the montgomery legal precenedt?

Answer 20

That a patients informed concent can not be taken until the practitioner has completed the test of materiality to ensure the patient has all the important information.

Question 21

What is the difference between a theoretical and an material risk?

Answer 21

Theorectical risk has a very low risk and is not always shared with the patient when gaining content.
Material risk - the risk has a high probability hence must be shared with the patient.

Question 22

How does the law distinguish between mental illness and mental disability?

Answer 22

Both need consent testing in different ways, a patient can be mentally ill but still have the capacity to give consent.

Question 23

What is the principle of undue influence relating to informed consent>

Answer 23

A patients withdrawl of consent of lack of consent can be ignored and considered to not have mental capacity, if they are overly influenced by another person, another illness etc.

Question 24

What is the deal of consent regarding a mother and her unborn child?

Answer 24

A patient can refues to give consent even is the claim would result in physical harm to the unborn child.

Question 25

What does the Mental Health Act 1983 and Mental Capacity Act 2005 change about mentally ill patients and consent?

Answer 25

A mentally ill patient can be treated without their consent, or can be detained against their will in order to protect themselves, third parties or the general public.
A mental health tribunal can challenge the involuntary powers of detention.
Under the 2005 act the patient lacks capacity is they are unable to decide for themselves if due to a mental impairment or disturbance in brain function.

Question 26

What is the law regarding minors and their parents in giving informed consent?

Answer 26

The parent may give consent on the child’s behalf if the decision is considered in the best interest of the child that any ‘reasonable parent’ would make.
This can also be used to override the minors informed consent.
This is most common in cases where the minor has impaired mental capacity such as anorexia nervosa where they may wish to not engage with treatment.

Question 27

What does the Gillick competency teach about consent regarding minors and contraceptives?

Answer 27

Under 16s with mental capacity can be given contraceptive without parental consent, if though harm will come to the child without, e.g they will continue to have sex without contraceptives.
The child should be encouraged to tell their parent and safeguarding checks should be made.
The minor must be considered intellectually mature inorder to make this decision.

Question 28

What is the key idea of a minor being intellectually mature?

Answer 28

The should be able to understand the nature of the clinical advice and mature enough to understand what is involved (e.g long term consequences and commitments).

Question 29

What are the Fraser guidelines of informed consent?

Answer 29

A minor can be given contraceptive treatment if:
- understand clinical advice
- cannot persuade the minor to inform their parents
- will continue to have sex without contraceptives
- mental or physical health will suffer without treatment
- is in the minors best interest
This can be applied to terminations of pregnancy and sexually transmitted diseases.

Question 30

Who has parental responsibility for a child?

Answer 30

Parental responsibility from 2003 lies with both parents if they are named on the birth certificate.
This continues if the parents are divorced.
Others may apply for a Parental Responsibility Agreement with the mother or a Parental Responsibility Order through the courts.
In IVF or assisted fertility responsibility is decided on a case by case basis.
Care Order - local authority
Voluntary care Order - parents
Legal rights end with adoption
In some cases schools have the rights in minor ailment treatments.