Discuss competence
-Who should be considered incompetent
-What should be done if the doctors is unsure regarding competence
-If not competent then who can consent be gained from
-If not competent and no one to give consent then what should be done
- Who is incompletent
-Everyone should be considered to have competence unless reasonable grounds for believing they are not
-Intellectually disabled
-Unconscious - If unsure of competence then consult
-Another doctor
-Seek legal advice - In individual not competent then can gian consent from:
-Legal gaurdian
-Enduring power of attorney for care and welfare - If incompetent and no one to give consent then:
-Act in best interest of the consumer
-Make reasonable attempts to determine what they would want
-Act in accordance with what the doctor believes the informed choice of the patient would be
Discuss providing care for the following situations
-Sterilisation in an incompetent patient
-Contraception in an incompetent patient
-Treatment in an emergency
- Sterilisation in an incompetent patient
-Parental consent is not sufficent basis to perform sterilisation
-Can perform in child if: parental consent, doctor satisfied that it is in the child’s best interest, least dramatic intervention
-In an adult sterilisation needs court intervention unless an emergency.
-Always get legal advice - Contraception
-Can administer contraception to women or girls who are sub-normal as long as in patients best interests
-If incompetent but not subnormal then need to seek legal advice - Treatment in an emergency
-A competent adult can refuse treatment in an emergency
-If the patient is not competent then urgent treatment to preserve life or avoid serious harm is required then treatment should be in their best interests
Discuss consent from children
- Gilick competence - based on understanding and maturity not age
- In NZ children >16yrs have the right to consent or refuse treatment. Parents cannot override
- Parents retain a gaurdianship role until 18 and can therefore give consent in the case of incompetence
- Seek leagal advice if the gaurdian refuses treatment for a child that the doctor believes is in the best interest of the child
- A child of any age can consent to a TOP if competent
Discuss RANZCOG guidelines for women with disability for contraception and fertility (4)
- Women have the right to make decisions about using contraception and which type to use including those with a disability
- Reversible methods including LARCS should be considered 1st line over irreversible methods
- Treatment offered to women with intellectual disability must be in accordance with legal jurisdiction
- Consult with experienced colleagues if considering irreversible approaches or if there is a lack of consensus around care.
Discuss requirements of duty to inform as per NZ code of rights - right 6 (5 points)
Patients can expect information about the following:
-Explanation of their condition
-Explanation of options available
-Estimated time of when services should be provided
-Whether they will be involved in teaching or research
-results of tests and procedures
