Consent Flashcards

1
Q

Consent

A

Patients have a fundamental legal and ethical right to make their own decisions; when applied to a patient’s agreement for a health professional to provide care this is termed consent.

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2
Q

Informed consent

A

Permission granted in full knowledge of the consequences

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3
Q

Valid consent

A
  • Be competent to take a particular decision
  • Received sufficient information
  • Not acting under duress
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4
Q

Explicit consent

A
  • Articulated agreement
  • Clear and voluntary indication of preference of choice
  • Orally/writing
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5
Q

Implied consent

A
  • Agreement that has been signalled by the behaviour of an individual
  • Discussion had been held about issues
  • e.g. patient rolls up sleeve and offers arm
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6
Q

Legal issues

A
  • Consent should be obtained before you examine, treat or care for a competent adult
  • Adults are always assumed to be competent to give consent unless demonstrated otherwise
  • Giving and obtaining consent is usually a process and not a one off event
  • A patient can withdraw consent at any time
  • Always best for the person actually treating the patient to seek the patient’s consent
  • Patient needs sufficient information
  • Consent must always be given voluntarily
  • Consent can be written, verbal or non-verbal
  • No-one can give consent for another adult
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7
Q

Sufficient information for a procedure

A
  • A description of the procedure to be undertaken
  • Any uncertainties about the effectiveness of the procedure
  • The benefits of the procedure
  • The risks of the procedure
  • Alternative treatments available with risks, burdens and benefits including the do nothing option
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8
Q

Delegated consent

A
  • Consent taken for a procedure by someone not competent to carry out the procedure
  • NHS Litigation Authority see this as a big patient safety issue
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9
Q

Mental Capacity Act 2005

A
  • Puts current best practice and common-law into a legal framework
  • Puts the needs and wishes of a person who lacks capacity at the centre of any decision-making
  • Replaces enduring power of attorney with a wider-reaching lasting power of attorney
    Reforms the Court of Protection (New Court of Protection)
  • Creates Independent Mental Capacity Advocacy (IMCA) Services to assist decision making for vulnerable unsupported adults in relation to serious medical treatment or placement in long-term care
  • Gives legal authorisation to the advanced refusal of treatment
  • Regulates the involvement of incapacitated adults in research
  • Creates a new criminal offence of wilful neglect or ill treatment of a person lacking capacity
  • Does not alter existing legal tests of capacity
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10
Q

Who will be affected by MCA

A
  • Dementia
  • Learning disabilities
  • Brain injury
  • Severe mental health problems
  • Planning for the future
  • Patients with temporary loss of capacity e.g. unconscious, delirium
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11
Q

5 principles of MCA

A
  1. Presumption of capacity
  2. Supported participation in decision-making
  3. A right to make unwise/eccentric decisions
  4. Best interest
  5. Least restrictive alternative
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12
Q

Incapacity

A

Fail to

  • Absorb basic information about the pros and cons of an issue or decision
  • Retain the information for long enough to process it
  • Use or weigh up the information
  • Communicate the decision by any means
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13
Q

Stage 1 Assessing Capacity

A
  • Impairment/disturbance in functioning of person’s mind/brain
  • Can be permanent/temporary
  • Due to person’s behaviour, circumstances, concerns raised by somebody else
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14
Q

Stage 2 Assessing Capacity

A
After been given appropriate help cannot
- Understand the information
- Retain the information
- Make and communicate a decision
(they lack capacity)
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15
Q

MCA - Public bodies supporting the statutory framework

A
  • New Court of Protection (implementation of the legislation, final arbiter in relation to decision-making under the act)
  • New Public Guardian (responsible for registration/fee and supervision of lasting power of attorney and court-appointed deputies)
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16
Q

Lasting Power of Attorney

A
  • Nominated to act on behalf
  • Must be registered with New Public Guardian
  • Includes decisions about finance, health and welfare
  • Doesn’t include decisions about withholding life-saving treatments unless specifically stated
  • If doctor is concerned can be referred to New Court of Protection
17
Q

Court-appointed Deputies

A
  • The Court of Protection can appoint deputies to makes decisions on welfare, health and finance
  • Cannot override an LPA/refuse life-sustaining treatments
18
Q

Independent Mental Capacity Advocate

A
  • If a person doesn’t have capacity, a LPA or a court deputy
  • Provided by local authority
  • Represent and support individual make sure act is followed - assist doctor
19
Q

Role of IMCA

A
  • Support
  • Obtain and evaluate relevant information
  • Person’s wishes and values
  • Report to decision-maker
20
Q

Advance Directives (living will)

A
  • Decision made to apply to circumstances where competence is lost in future
  • Only relates to refusal of treatment
  • Oral/written (except refusal of life saving treatment)
  • Cannot refuse basic treatment
  • Can request specific treatment (not always followed)
21
Q

Refuse of life saving treatment must:

A
  • Be in writing
  • Be signed and witnessed
  • The treatment refused must be specific
  • It must be clear that the decision stands even if life is at risk
  • The AD must be valid at the time and applicable to the circumstances
22
Q

Section 6 of MCA

A

Permits restraint/deprivation of liberty when

  • necessary to prevent harm
  • proportionate to the likelihood and seriousness of harm
  • for convenience of carers
23
Q

Ill treatment/neglect

A

Maximum 5 years in prison