Consent

Question 1

What is consent?

Answer 1

Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination

Question 2

Who must gain consent?

Answer 2

Clinician with appropriate experience and expertise who can give an explanation

Question 3

What are different expressions of consent?

Answer 3

• Implied or verbal agreement for non-invasive treatments e.g. BP, ECG
• Express consent for minor or routine investigations e.g. IV access, ABG
• Written consent for procedures of high risk e.g. surgery
• Examination of intimate zones with lack of adequate consist renders practitioner liable for indecent assault

Question 4

What happens if there is examination or treatment without appropriate consent?

Answer 4

Can be liable of indecent assault or common assault

Question 5

What is informed consent?

Answer 5

Patient should be informed of the practicalities of the procedure, benefits/risks of procedure and benefits/risks if procedure not done or refusal of treatment

Question 6

What happens if patients asks for treatment that doctor considers would not be of overall benefit to them?

Answer 6

Do not have to provide the treatment

Should explain their reasons to the patient, explain other options available, including option to seek second opinion

Question 7

What should recording decisions involve?

Answer 7

Use patients medical records or a consent form to record key elements of your discussion with the patient
Should include info you discussed, any specific requests by the patient, any written, visual or audio info given to patient and details of any decision made

Question 8

When should review decisions with patient?

Answer 8

Before beginning treatment, should check patient still wants to go ahead and respond to any new or repeated concerns or questions

Question 9

When is reviewing decisions important with patients?

Answer 9

If significant time has passed since the initial decision was made
There have been material changes in patient’s condition or any aspect of the proposed

Question 10

What does capacity mean for consent?

Answer 10

Patients with capacity can make their own decisions to refuse treatment, even if these decisions appear irrational to doctor or may place patients health or life at risk

Question 11

What is capacity?

Answer 11

Patient can understand, believe, retain and weight the necessary information given to them to make a decision

Question 12

What are examples of obstacles to capacity?

Answer 12

Impaired intellectual/mental capacity
Intoxication
Unconsciousness
Communication issues: hearing, mute, language
Age

Question 13

What act governs making decisions about treatment and care for patients who lack capacity in Scotland?

Answer 13

Adults with Incapacity (Scotland) Act 2000

Question 14

For the purposes of the Adults with Incapacity Act 2000, what does incapable mean?

Answer 14

Incapable of:

• acting on decisions
• making decisions or: communicating decisions, understanding decisions, retaining the memory of decisions
• in relation to mental disorder or inability communicate because of physical disability

Question 15

What are the 5 principles of the Adults with Incapacity Act?

Answer 15

1. Any action or decision taken must benefit the person
2. Least restrictive option
3. Take account wishes of person
4. Consultation with relevant others
5. Encourage person to use existing skills and develop new skills

Question 16

What decisions can never be made on behalf of person who lacks capacity?

Answer 16

Consent to marriage

Making a will

Question 17

What can a proxy not do on behalf of a person without capacity?

Answer 17

Cannot place person in mental hospital against his/her will

Consent to certain treatments on his/her behalf

Question 18

What is power of attorney?

Answer 18

A means by which individuals, whilst they still have capacity, can grant someone they trust powers to act as their continuing (financial) and/or welfare attorney

Question 19

When does a persons power of attorney commence?

Answer 19

When granter loses capacity

Question 20

Who must all powers of attorney under Adults Without Capacity act be registered with?

Answer 20

The Public Guardian

Question 21

What happens if person does not have capacity to make decision about treatment and have not appointed power of attorney?

Answer 21

Healthcare professionals can administer treatment if they believe it’s in the person’s best interests
Discussion with friends/relatives
If disagreement - case may be taken to court

Question 22

What happens if need consent for treatment and impairment with drugs/alcohol/unconsciousness?

Answer 22

If poss - wait until patient able to consent

If life-threatening - act on behalf of patient to perform procedure in their best interest

Question 23

In Scotland, what is the definition of a child?

Answer 23

Under 18

However, Children’s hearings/child protections orders, child under 16

Question 24

At what age are people entitled to consent to own treatment?

Answer 24

16+

Question 25

When can children under age 16 consent to own treatment?

Answer 25

If believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment = Gillick competence

Question 26

What is Gillick competence?

Answer 26

If child under 16yo believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment

Question 27

When can consent be overruled in young person?

Answer 27

If young person refuses treatment, which might lead to their death of severe permanent injury - decisions can be overruled by Court of Protection

Question 28

What is the Court of Protection?

Answer 28

Legal body that oversees operation of Mental Capacity Act (2005)