Consent

Question 1

Consent

Answer 1

Patients have a fundamental legal and ethical right to make their own decisions; when applied to a patient’s agreement for a health professional to provide care this is termed consent.

Question 2

Informed consent

Answer 2

Permission granted in full knowledge of the consequences

Question 3

Valid consent

Answer 3

• Be competent to take a particular decision
• Received sufficient information
• Not acting under duress

Question 4

Explicit consent

Answer 4

• Articulated agreement
• Clear and voluntary indication of preference of choice
• Orally/writing

Question 5

Implied consent

Answer 5

• Agreement that has been signalled by the behaviour of an individual
• Discussion had been held about issues
• e.g. patient rolls up sleeve and offers arm

Question 6

Legal issues

Answer 6

• Consent should be obtained before you examine, treat or care for a competent adult
• Adults are always assumed to be competent to give consent unless demonstrated otherwise
• Giving and obtaining consent is usually a process and not a one off event
• A patient can withdraw consent at any time
• Always best for the person actually treating the patient to seek the patient’s consent
• Patient needs sufficient information
• Consent must always be given voluntarily
• Consent can be written, verbal or non-verbal
• No-one can give consent for another adult

Question 7

Sufficient information for a procedure

Answer 7

• A description of the procedure to be undertaken
• Any uncertainties about the effectiveness of the procedure
• The benefits of the procedure
• The risks of the procedure
• Alternative treatments available with risks, burdens and benefits including the do nothing option

Question 8

Delegated consent

Answer 8

• Consent taken for a procedure by someone not competent to carry out the procedure
• NHS Litigation Authority see this as a big patient safety issue

Question 9

Mental Capacity Act 2005

Answer 9

• Puts current best practice and common-law into a legal framework
• Puts the needs and wishes of a person who lacks capacity at the centre of any decision-making
• Replaces enduring power of attorney with a wider-reaching lasting power of attorney
  Reforms the Court of Protection (New Court of Protection)
• Creates Independent Mental Capacity Advocacy (IMCA) Services to assist decision making for vulnerable unsupported adults in relation to serious medical treatment or placement in long-term care
• Gives legal authorisation to the advanced refusal of treatment
• Regulates the involvement of incapacitated adults in research
• Creates a new criminal offence of wilful neglect or ill treatment of a person lacking capacity
• Does not alter existing legal tests of capacity

Question 10

Who will be affected by MCA

Answer 10

• Dementia
• Learning disabilities
• Brain injury
• Severe mental health problems
• Planning for the future
• Patients with temporary loss of capacity e.g. unconscious, delirium

Question 11

5 principles of MCA

Answer 11

1. Presumption of capacity
2. Supported participation in decision-making
3. A right to make unwise/eccentric decisions
4. Best interest
5. Least restrictive alternative

Question 12

Incapacity

Answer 12

Fail to

• Absorb basic information about the pros and cons of an issue or decision
• Retain the information for long enough to process it
• Use or weigh up the information
• Communicate the decision by any means

Question 13

Stage 1 Assessing Capacity

Answer 13

• Impairment/disturbance in functioning of person’s mind/brain
• Can be permanent/temporary
• Due to person’s behaviour, circumstances, concerns raised by somebody else

Question 14

Stage 2 Assessing Capacity

Answer 14

After been given appropriate help cannot
- Understand the information
- Retain the information
- Make and communicate a decision
(they lack capacity)

Question 15

MCA - Public bodies supporting the statutory framework

Answer 15

• New Court of Protection (implementation of the legislation, final arbiter in relation to decision-making under the act)
• New Public Guardian (responsible for registration/fee and supervision of lasting power of attorney and court-appointed deputies)

Question 16

Lasting Power of Attorney

Answer 16

• Nominated to act on behalf
• Must be registered with New Public Guardian
• Includes decisions about finance, health and welfare
• Doesn’t include decisions about withholding life-saving treatments unless specifically stated
• If doctor is concerned can be referred to New Court of Protection

Question 17

Court-appointed Deputies

Answer 17

• The Court of Protection can appoint deputies to makes decisions on welfare, health and finance
• Cannot override an LPA/refuse life-sustaining treatments

Question 18

Independent Mental Capacity Advocate

Answer 18

• If a person doesn’t have capacity, a LPA or a court deputy
• Provided by local authority
• Represent and support individual make sure act is followed - assist doctor

Question 19

Role of IMCA

Answer 19

• Support
• Obtain and evaluate relevant information
• Person’s wishes and values
• Report to decision-maker

Question 20

Advance Directives (living will)

Answer 20

• Decision made to apply to circumstances where competence is lost in future
• Only relates to refusal of treatment
• Oral/written (except refusal of life saving treatment)
• Cannot refuse basic treatment
• Can request specific treatment (not always followed)

Question 21

Refuse of life saving treatment must:

Answer 21

• Be in writing
• Be signed and witnessed
• The treatment refused must be specific
• It must be clear that the decision stands even if life is at risk
• The AD must be valid at the time and applicable to the circumstances

Question 22

Section 6 of MCA

Answer 22

Permits restraint/deprivation of liberty when

• necessary to prevent harm
• proportionate to the likelihood and seriousness of harm
• for convenience of carers

Question 23

Ill treatment/neglect

Answer 23

Maximum 5 years in prison