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Medical law > Consent in adults and children, emergency and non-emergency situations > Flashcards

Consent in adults and children, emergency and non-emergency situations Flashcards

1
Q

What is the meaning of medical battery?

A

Harmful/offensive touching of another person in a medical setting

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2
Q

Give 2 ways in which an operation can constitute medical battery?

A

Incorrect site of surgery

Wrong operative procedure performed

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3
Q

How can deciding what treatment a patient receives constitute medical battery in 2 ways?

A

Ignoring a specific prohibition of the treatment, which can be dangerous for patient

Giving unnecessary/additional treatment that isn’t clinically indicated, but doctor thinks its convenient

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4
Q

How can a patient’s consent status constitute medical battery?

A

Ignoring a patient’s withdrawal of consent

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5
Q

How can patient be appropriately informed about a treatment, regardless of how complex the treatment is?

A

The more complex the treatment, the more details the patient must be given by clinician

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6
Q

What is informed/medical consent, and what 2 factors must be discussed to constitute this?

A

Permission granted by patient in knowledge of possible consequences

Need to discuss material risk, any complications

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7
Q

Must consent be given voluntarily by the patient?

A

Yes, not under influence, coercion, duress

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8
Q

Give 3 ways in which consent is made patient-centered in a consultation?

A

Clinician involves patient in dialogue

Clinician listens to patient’s choice

Clinician supports patient’s right to individualism

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9
Q

What Act provides principles on how an individual without capacity can give consent?

A

Mental Capacity Act 2005

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10
Q

How many key principles are in the Mental Capacity Act 2005?

A

5

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11
Q

Describe the principle ‘presumption of capacity’ of Mental Capacity Act 2005?

A

Must assume that an individual has capacity unless proven otherwise, and can’t assume that an individual doesn’t have capacity because they have an illness/disability

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12
Q

Describe the principle ‘Right to support when making decisions’ of Mental Capacity Act 2005, and list 3 ways in which this is applied?

A

Maximise capacity by considering alternate formats to present information in, such as pictures, sign language, considering meeting locations and times

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13
Q

Describe the principle ‘Unwise decision can’t be seen as wrong decision’ of Mental Capacity Act 2005?

A

Clinician must respect individuals choices and views even if they disagree

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14
Q

If an individual suddenly makes an ‘unwise’ decision according to the clinician, why could this warrant further investigation?

A

Can indicate that individual is being coerced into making that decision

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15
Q

Describe the principle ‘best interests at heart of decision making’ of Mental Capacity Act 2005?

A

If it has been proven that individual lacks capacity, all decisions/actions must be made in their best interest

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16
Q

Describe the principle ‘least restrictive intervention’ of Mental Capacity Act 2005?

A

All decisions must promote rights and freedom of the individual

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17
Q

What test is provided in the Mental Capacity Act 2005, that tests capacity?

A

Two stage test

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18
Q

Describe stage 1 of the two stage test for capacity?

A

Does the patient suffer from impairment/disturbance in function of the mind or brain?

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19
Q

Describe stage 2 of the two stage test for capacity?

A

Does the impairment/disturbance in function of brain or mind make the individual unable to make a decision at that time?

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20
Q

What test is used in stage 2 of the two stage test for capacity, and what 4 factors are questioned in this test?

A

Functional test determines whether patient is able:
To understand info relevant to the decision

To retain info

To use/weigh that info as part of the decision making process

To communicate their decision (by any means)

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21
Q

Does an individual with a mental illness still have capacity?

A

Yes

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22
Q

How can temporary factors affect an individual’s capacity, and list 4 temporary factors?

A

Temporary factors can temporarily make individual lack capacity, so any decisions made by clinicians must be sure that these factors rendered individual’s capacity absent before making decisions in their interest

eg. Shock, drugs, needle phobia, pain

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23
Q

How can encouraging patient participation and exploring their views in consultations allow clinicians to act in their best interest, in 2 ways?

A

Clinician can avoid assumptions/discrimination

Clinician will know how to act in all relevant circumstances

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24
Q

What 2 questions should a clinician consider when making a decision to act in patient’s best interests, especially if it is a potentially fatal circumstance?

A

Will patient regain capacity

Is the decision for life-sustaining treatment

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25
Q

When deciding to act in a patient’s best interests, should the clinician make this decision alone?

A

No, they have a duty to consult peers, and gain a second opinion

Can also consult ethics committee

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26
Q

Why should a court declaration be obtained when acting in a patient’s best interests?

A

states whether patient had capacity or not, and if the decision in their best interests was lawful

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27
Q

When a decision is made in the patient’s best interests, what 4 pieces of info must be documented?

A

How the decision about best interests was reached

What the reasons for reaching the decision were

Who was consulted

What particular factors were taken into account

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28
Q

What is a material risk?

A

Risk that a reasonable person in the patient’s position would attach significance to, or that doctor knows a patient would attach significance to

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29
Q

What 3 factors should be considered by clinicians when determining if a treatment has material risk to a patient?

A

Consider effect of treatment on patient

Consider importance of benefits of/desire to have the treatment to patient

Consider alternative treatments and their risks

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30
Q

What is the doctor’s role regarding material risks of treatments?

A

To advise patient through comprehensible means about any material risks of any treatments and their alternatives, so that they can give informed consent

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31
Q

Give an example of material risks in practice?

A

Very rare but severe side effects that patient would like to be aware of before consenting to start treatment

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32
Q

Give 3 examples of material risks of surgery?

A

Sequela

Failure to cure

Complications

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33
Q

What is a sequela in surgery, and why are they material risks?

A

Aftereffect of surgery that is inherent (inevitable) to the procedure

Patient will definitely experience it, so they should be informed about it

34
Q

What is meant by ‘failure to cure’ in surgery, and why is it a material risk?

A

surgery executed without complications but original objective of surgery not achieved

Patient should be prepared for this difficult outcome instead of becoming absolutely sure that the surgery will cure them, as this is dishonest

35
Q

What are complications in surgery, and why are they material risks?

A

Unsavoury, unanticipated, secondary or additional disease

Will make recovery harder, so patient should be aware of them

36
Q

Are medical students allowed to obtain valid consent for a procedure?

A

No

37
Q

Who’s responsibility is it to obtain valid consent from a patient for a procedure?

A

The doctor performing the procedure, unless they delegate the responsibility to another MDT member competent to complete the procedure

38
Q

What 4 skills must the MDT member obtaining valid consent have?

A

Sufficient knowledge of risks and benefits of the treatment

Communication skills

Competent to perform treatment themselves

Suitably trained

39
Q

If the responsibility of obtaining consent from a patient is delegated inappropriately, is the consent valid?

A

No, this invalidates the consent, and so if the procedure is performed this constitutes medical battery as the patient hasn’t given valid consent

40
Q

For what type of procedure is non-verbal consent valid?

A

Quick, minimally-invasive procedure

41
Q

What 3 things must a clinician do if they perform a quick, minimally-invasive procedure with non-verbal consent?

A

Explain to patient what they are doing and why

Clearly explain to patient that they can stop procedure at any time

Be alert during explanations and procedure itself of patient’s happiness/confusion

42
Q

Why is it important to take listen to a child patient’s decisions, choices when obtaining consent on behalf of that child patient?

A

Children have rights that must be respected and doctor should always act in the child’s best interests

43
Q

Why can it be difficult to identify what a child patient’s best interests are?

A

They might not completely understand treatment details and so won’t have capacity

44
Q

When can a child consent to their own treatment?

A

If they have capacity and are Gillick competent

45
Q

When a child lacks capacity, who has right to act in the child’s best interests and give valid consent for the child’s treatment?

A

Parents/legal guardians of the child

Court

46
Q

If the parent/legal guardian of the child patient won’t act in child’s best interests, how can the medical team of the child patient prevent this from progressing?

A

Medical team can apply for court order, should also involve hospital legal team and Safeguarding Children lead

47
Q

In which situation can you provide treatment without any consent on the child patient’s behalf?

A

Emergency situation to save the child’s life

48
Q

Can children ages 16 and 17 give valid consent for their own treatment?

A

Yes, as it is legally presumed that when a child turns 16 they have capacity to make decisions about their own care

49
Q

What does the Gillick competence state about parental rights compared to the child patient’s rights for making decisions about the child’s treatment?

A

Parental rights yield to the child’s right to make own decisions

50
Q

What 2 qualities must a Gillick competent child patient have to make up their own mind regarding their treatment and give consent?

A

Sufficient intelligence and understanding to make informed decisions

51
Q

If a child refuses treatment, which 2 bodies can override their refusal and give consent on the child’s behalf?

A

Persons with Parental Responsibility

Court

52
Q

How are disputes about a child’s treatment settled, and what are the 2 possible outcomes?

A

Case is referred to court who either:

Impose inherent jurisdiction, which protects individual’s right to own decision making

Impose treatment in child’s best interests, overriding child’s refusal

53
Q

What are the 3 types of consent?

A

Implied: patient is presenting to clinician to be examined, or can give permission non-verbally

Oral: verbal conversation gaining permission this is often formalised after encounter with documentation in the notes

Written: pre-emptive, involved, best supported in law

54
Q

What are the 2 types of explicit consent?

A

Oral: verbal conversation gaining permission this is often formalised after encounter with documentation in the notes

Written: pre-emptive, involved, best supported in law

55
Q

Should treatment options outside the UK also be discussed with the patient?

A

Yes, as this would constitute the patient being informed about all treatment options

56
Q

What 4 qualities should a reasonable alternative treatment option have?

A

Must have known, established procedure

Must be accepted practice

Must be an appropriate option, not a possible option.

Not a variant of current Treatment

57
Q

Give 3 examples of situations in which a clinician can withhold info about a treatment from a patient?

A

Patient says that they don’t want to know the info

Necessary situation eg. emergency with unconscious patient

Knowing this info would be severely detrimental to patient’s health

58
Q

In order to find out what info matters to a patient so that you can act in their best interests if needed, do you need to explain even small risks or procedure details?

A

Yes, must explain everything no matter how small the information

59
Q

When you explain the treatment to a patient, how do you tailor the explanation to be patient-centred?

A

Prioritise risks according to what would affect that specific patient the most eg. a partially blind person would consider full-blindness an important risk

60
Q

What 3 things do you need to ask the patient about to find out what treatment info is important to them?

A

Needs, wishes, priorities

61
Q

How does a doctor determine what language and approach to use with each patient so that the info is delivered in a comprehensible way?

A

Determine the patient’s current level of knowledge and understanding of the treatment and risks

62
Q

Does the nature of the patient’s condition affect the complexity of the treatment and level of risk, and should the patient be made aware of this?

A

Yes, the patient should be told this

63
Q

When explaining a treatment to a patient, where are recognised risks from?

A

Royal Colleges

64
Q

Can a clinician assume what info a patient would like to know about a treatment?

A

Never assume, should always give patient all info

65
Q

If a treatment/investigation is complex or has significant risks, is written consent required?

A

Yes

66
Q

If a treatment/investigation will have significant effects on a patient’s social, personal lives and employment, is written consent required?

A

Yes

67
Q

If providing clinical care isn’t the purpose of treatment/investigation for a patient, do they need to sign a written consent form to proceed?

A

Yes

68
Q

If the treatment of a patient is for a research programme, what kind of consent is required?

A

Written consent (explicit)

69
Q

Give one example of a specific treatment that requires written consent?

A

Fertility treatment

70
Q

What does the common law doctrine of necessity state about treating patients in emergency conditions without gaining consent first?

A

Not gaining consent is justified if the treatment is a necessity and the clinician does no more than is reasonably needed to treat the patient (they use least restrictive course of treatment)

71
Q

When treating a patient in a situation where their consent wasn’t gained first, how can you prove that you acted in their best interests?

A

Document everything so that you can justify your reasoning for treating that patient eg. state that it was a life-threatening situation and patient was unconscious

72
Q

What 2 steps does GMC para 62-64 guidelines provide on how to deal with emergency situation with unconscious patient?

A

Provide treatment that is immediately necessary to save patient’s life/prevent serious deterioration

Wait for patient to become conscious and regain capacity, then explain administered emergency treatment and discuss ongoing treatment

73
Q

Give 3 examples of situations in which the Mental Health Act states that the patient should be treated, even if they are are competent but refusing treatment?

A

Patient has severe mental health issue

Patient has attempted suicide

Patient has attempted severe self-harm

74
Q

How is a mentally-ill patient sectioned (kept in hospital in treatment) according to the Mental Health Act?

A

Social care worker or relative need to make an application, then 2 doctors are needed to section patient

75
Q

If an individual is severely ill and living in unhygienic conditions, can they be taken to a place of care without their consent?

A

Yes

76
Q

In situations where treatment s given without consent, what factor determines if this otherwise unlawful act is justified?

A

The imminence and severity of the threat that the patient is facing

77
Q

How many consent forms are there, and what is each form for?

A

There are 4 standard consent forms

Form 1 - adults or children with mental capacity

Form 2 - parental consent to treatment/investigation of a child or YP

Form 3 – procedure specific consent form.

Form 4 - adults who lack mental capacity

78
Q

Is it sufficient to obtain a signed consent form from a patient instead of discussing the treatment with the patient?

A

No, but a consent form is helpful in prompting the patient to share and ask for info, and is a standardised way to record decisions

79
Q

Does the patient also keep a copy of the signed consent form?

A

Yes

80
Q

List the 3 steps in the consent process for undergoing an operation?

A

New patient clinic (GP), where patient is given consent letter

Pre-operative assessment with written consent

Confirmation and re-checking of consent on day of procedure

Medical law (8 decks)

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