Consent

• Types of consent:

  • Implied
  • Sits in chair and opens mouth
  • Expressed
  • Oral or written
  • Oral - routine "low risk"
  • Written - extensive intervention or GA/sedation
• Patient possesses the 3 key abilities to give informed consent:

  1. Able to comprehend and retain information
  2. Believe information given
  3. Able to weigh it in balance to make a choice
  4. Communicate
  5. Understand
  6. Retain
  7. Evaluate
• Process of obtaining consent:

  • Use Lay language
  • Explain procedure's purpose
  • Explain benefits, risks and alternatives
  • Explain consequences of no intervention
  • Do all of above without duress
• Competency for giving consent:

  • 16 and over demonstrating 3 key abilities
  • Able to comprehend and retain information
  • Believe information given
  • Able to weigh it in balance to make a choice
  • Under 16 - may demo competence "Gillick competence" otherwise treat as child
• Children - parental responsibility:

  • Children's act 1999 parental responsibility lies with:
  • Parents if married at time of birth
  • Mother if not married at time of birth unless father on birth certificate or they marry or he gains responsibility via court order
  • Legal guardian
  • Local authority if in care
• Lack capacity to consent:

  • Refusal does not = lack capacity
  • Re-discuss to clarify but not to persuade
  • Lack capacity = essentially lacking the 3 abilities
  • Seek advice from physician they're under the care of
• Mental capacity act 2005:

  • Statutory duty for health (and other) care professionals
  • Advance decisions to refuse treatment
  • Lasting power of attorney
  • IMCA (Independent Mental Capacity Advocate)
  • Court of protection
  • Deprivation of liberty safeguards
• Mental capacity act 2005:

  • 5 principles of capacity
  • Assume capacity unless established they lack it
  • Don't treat person as unable to make decisions unless all practicable steps to help them make the decision have all been undertaken and failed
  • Person is not unable to make decisions simply because they make an unwise decision
  • Any act done or decision made on behalf of someone lacking capacity has to be in their best interests
  • Any act done or decision made should be the least restrictive of the person's rights and freedom of action
• Consenting those lacking capacity:

  • Next of kin can't consent, but should be involved
  • No next of kin -> IMCA (independent mental capacity advoncate)
  • Scotland - proxy can be legally empowered
  • England - Lasting Power of Attorney can be granted (financial [property & affairs]; social and health care)
  • Must be registered with Office of public guardian
  • Else 2 doctors/dentists - "patient's best interests"
• Patient's best interests, take into account:

  • Risks, benefits, and circumstances
  • Evidence of patient's views e.g. Advance statement
  • Your knowledge of patient's views and that of other members of health team
  • Whether patient will regain capacity - non-urgent decision? Put off
• Patient's best interests must be informed by:

  • Treatment option that gives patient most choice in future
  • Views of patient's partner or relatives
• Best interests:

  • Avoid discrimination
  • Examined by Bolam test
  • Would a reasonably competent health professional have acted in the same way?
  • Further examined by Bolitho test
  • Could a judge deem the professional opinion illogical due to other expert testimony?
• Withdrawing consent:

  • Need to be competent
  • Cry of anguish - doesn't necessarily mean withdraw consent
  • Pause procedure discuss concerns, address concerns, exp consequences of stopping procedure at this point
  • If wish to stop and are competent then STOP