Consent and Capacity

Question 1

what is the definition of consent?

Answer 1

• the voluntary and continuing permission of an appropriately informed individual who has the capacity to consent to the intervention in question
• based on sufficient knowledge of the purpose, nature, likely effects and risks of that treatment, including the likelihood of its success and any alternatives to it
• acquiescence under any unfair or undue pressure, or where the person does not know what the intervention entails, is not consent

Question 2

what two things must consent always be?

Answer 2

• valid

- legal

Question 3

what is the meaning of valid consent?

Answer 3

the consent:

• remains current
• was obtained recently enough
• specific to the proposed dental treatment only

Question 4

how long does consent remain valid?

Answer 4

• consent should be a continuing process
• if there has been a significant interval between consent and treatment, consent should be renewed
• the patient should be given continuing opportunities to ask questions and renew any decisions made

Question 5

what are the 3 main principles of legal consent?

Answer 5

• ABILITY
• INFORMED
• VOLUNTARY

Question 6

what does the principle ‘ability’ refer to by means of obtaining legal consent?

Answer 6

the patient has the ability to make an informed decision

Question 7

what does the principle ‘informed’ refer to by means of obtaining legal consent?

Answer 7

the patient has enough information to make a decision

Question 8

what does the principle ‘voluntary’ refer to by means of obtaining legal consent?

Answer 8

the patient themselves made the decision (not coerced etc)

Question 9

what is the meaning of capacity?

Answer 9

capacity is the power to act/make decisions

Question 10

what are the different aspects that allow a person to have capacity?

Answer 10

• able to make a reasoned decision
• able to communicate said decision
• able to understand a decision
• able to retain the memory of a decision

Question 11

when might a person not be able to make a reasoned decision?

Answer 11

if the decision is random or impulsive

Question 12

when might a patient not be able to communicate a decision?

Answer 12

• poor/no english

- unconscious

Question 13

how can you determine if a patient is able to understand a decision?

Answer 13

• must have cognitive thinking abilities

- must be able to understand consequences

Question 14

can someone else lawfully give consent for another person if that person has capacity?

Answer 14

NO

Question 15

what is meant by obtaining INFORMED consent?

Answer 15

• sufficient information must be communicated to the patient in order for them to make an informed decision about whether or not to accept the treatment
• this is based on appropriate knowledge and understanding

Question 16

how can a dentist ensure they receive consent that is informed?

Answer 16

• specific questions from/to the patient must be answered fully and honestly
• any information communicated must be documented
• treatment cannot exceed the consent given

Question 17

in reference to consent, what are “material risks” and how does this affect dentistry?

Answer 17

• the dentist must be aware (or is reasonably aware) that the particular patient, if warned of the risks, would be likely to attach significance to these

Question 18

a patient under the age of 16 is in your practise, can they give valid consent to dental procedures?

Answer 18

• if they have sufficient maturity and intelligence to understand the nature & implications of the treatment then…. YES

Question 19

if an adult is giving capacity for a child, what must you always ensure?

Answer 19

the adult consenting to procedures has parental responsibility

Question 20

who has parental responsibility?

Answer 20

• mum = automatically
• dad = must be married to mum or be on birth certificate
• other/step-parent = must have court authority, parental responsibility agreement or adoption

Question 21

what is the purpose of the Adults With Incapacity (Scotland) Act?

Answer 21

it safeguards the interests of adults who have difficulty understanding and making decisions

Question 22

what is power of attorney?

Answer 22

the patient has formally nominated a person to make their decisions prior to losing capacity

Question 23

what are the two types of power of attorney?

Answer 23

• wellfare PoA

- continuing PoA

Question 24

what does wellfare power of attorney refer to?

Answer 24

the care and personal needs of the adult (health care, clothing etc)

Question 25

what does continuing PoA refer to?

Answer 25

finance and property

Question 26

what is an intervention order?

Answer 26

used in a situation where there is no PoA & a decision needs to be made on behalf of the adult with incapacity

Question 27

what are the five principles of the Adults with Incapacity (Scotland) Act?

Answer 27

the use of the act must be allied with:

• the benefit of the adult
• minimum intervention
• present and past wishes of the adult
• consultation with the adult and others
• the adults exercising of their skills and further development of these

Question 28

in order for autonomy to be established within the dental practise, what two things are required?

Answer 28

consent and capacity

Question 29

what must valid and legal consent be?

Answer 29

• voluntary
• not coerced
• not manipulated
• with capacity
• obtained recently
• informed

Question 30

when is consent not required?

Answer 30

• in an emergency when the treatment is immediately necessary to save the patients life or prevent deterioration of their condition