Ethics of Consent, Capacity and Confidentiality Flashcards
If a patient has capacity to make a decision that may not be recommended by medical staff, then we must accept this decision is in the patient’s best interests.
What reasons may they have for this decision?
- Happiness and pleasure?
- Self-fulfilment?
- Keeping one’s dignity?
- Absence of pain and suffering?
- Life/surviving at any cost?
- Consideration for family?
What are the only times that an adult over the age of 16 can be treated without their consent?
- If it is an emergency (NOT just presenting to A&E)
- You can apply the Adults with Incapacity Act (form)
- You can apply the Mental Health (Scotland) Act
What legal issues can doctors face if they fail to consent a patient to treatment?
- Battery - “unlawful touching”
=> person need not be harmed by procedure to claim damages - Negligence
- If relevant information is not provided
Consent is not equivalent to contract. What are the differences between the two?
Consent = Not binding
=> There are no consequences of withdrawal and this must be respected
Contract = Binding
=> Withdrawing may have consequences (e.g. financial penalties)
Why does consent need to be continually given throughout a patient’s treatment?
- Valid consent is a continuous process, not just ONE signature
- just because a patient is okay with one procedure does not mean they will be okay with all
How do we aim to allow patients to make a fair decision on their treatments?
- discuss all treatment options openly
- respect the patients views
- let them decide
How can we improve our patient’s capacity to consent?
- Additional support (e.g. pictures or other aids)
- Use simple language
- Suggest they bring a relative, friend or translator
- Address patient’s unspoken anxieties (e.g. fear of pain or other underlying problems)
- Give patient time to reflect upon their decision
- Allow time for them to ask questions
How can you check if a patient has or lacks capacity?
Do they:
- Understand the treatment options and can weigh up
the benefits and risks? - Retain the information provided
- Weigh up, decide and communicate their decision
For what reasons may a patient have capacity yet be unable to communicate their decision?
- Locked in syndrome
- Stroke
etc
What are the 3 requirements for VALID consent?
- Patient has capacity
- Patient received enough information and understands
- Voluntariness: deciding voluntarily (not coerced)
How must a patient be treated in an emergency if no consent has been given?
- Treated without consent if immediately necessary to save a life or prevent deterioration
- Treatment must be least restrictive of the patient’s future choices
If there is uncertainty or disagreement as to whether valid consent was obtained, who can you contact?
- more senior colleague for advice
- independent advisor
- defence organisation (e.g. Medical Defence Union)
- professional body
- Clinical Ethics Committee
- independent court/statutory ruling
What are the basic rules on how children are treated as they do not have capacity to consent?
- Parent/s (or legal guardian/s) must be consulted about child’s treatment (unless absolute emergency)
- Parents make decisions and must be consulted from birth
- Child’s consent should ideally be sought even from
toddlers - The State must protect the best interests of the child, => can override parents’ (guardians’) wishes (e.g. in situations of child neglect/abuse)
What can occur if parents disagree with the healthcare team?
Judge (courts) can assess the situation and override parents’ refusal of consent if they feel medical treatment is necessary
All people aged 16 and over are presumed in law to have the capacity to consent to treatment unless there is evidence to the contrary. TRUE/FALSE?
TRUE
