Consent and Confidentiality Flashcards
(34 cards)
Define consent.
Consent is the voluntary and continuing permission of the patient to receive a particular treatment based on an adequate knowledge of the purpose, nature, and likely risks including the likelihood of its success and any alternatives to it. Permission given under undue or unfair pressure is not consent.
Why is consent important ?
- Legally: Treating a competence patient without consent is a criminal offense (assault)
- Good clinical care: Based on the principle of autonomy
What are the main types of consent ? Give an example for each.
- Implied (i.e. actions, e.g. baring arm of venipuncture)
- Expressed (i.e. deliberate, clear consent e.g. written or oral)
Is there a legal requirement for written consent over oral consent ?
No, rarely a legal requirement for written consent (however, may be required under Human Fertilization and Embryology Act + some mental health situations)
Need evidence but not proof of consent
Identify situations where consent is invalid despite proof of written consent.
Written consent merely serves as evidence of consent: if the elements of voluntariness, appropriate information and capacity have not been satisfied, a signature on a form will not make the consent valid.
What types of treatment is written consent good practice (although in most cases still not required) for ?
Surgery
Describe the principles of consent and confidentiality as listed by the GMC.
Emphasis on “partnership”.
Emphasis on providing information.
Places responsibility for ensuring patients have information they need squarely upon the doctor.
Specifies what you must inform patients.
Summarise the “Adults with Incapacity (Scotland) Act 2000”.
For the purposes of this Act, and unless the context otherwise requires— “adult” means a person who has attained the age of 16 years; “incapable” means incapable of— (a) acting; or (b) making decisions; or (c) communicating decisions; or (d) understanding decisions; or (e) retaining the memory of decisions
– Therefore, it applies to all people aged 16 and over who lack capacity to make some or all decisions for themselves
– The Act aims to protect people who lack capacity to make particular decisions, but also to support their involvement in making decisions about their own lives as far as they are able to do so.
Describe the relationship between consent and capacity.
Capacity is necessary to give valid consent.
True or false: nobody can consent on behalf of an adult with capacity. Even if they sometimes make unwise decision ?
True
What is the right course of action to take if an adult patient with capacity makes a decision the doctor sees as unwise ?
Document carefully, offer second opinions and time for the patient to reconsider.
What is the piece of legislation concerning lack of capacity in adults in Scotland ? In England and Wales ?
Adults with Incapacity Act
Mental Capacity Act
Summarise the Mental Capacity Act.
Principle 1 - benefit
Principle 2 - least restrictive option
Principle 3 - take wishes of the person into account
Principle 4 - consult with relevant others
Principle 5 - encourage the person to use existing skills and develop new skills
Summarise GMC Guidance on capacity issues in children.
- Involve the child as much as possible
- Does the child have capacity to consent, i.e. can they understand (nature, purpose, possible consequences), retain + use + weight information, and communicate decision ?
- Time and decision specific
Describe the legislation around the consent of young persons 16 and under 16 in Scotland and England.
SCOTLAND (Statutory power)
- Age of legal capacity allows a person aged over 16 to enter into any transaction, and a person under 16 shall have legal capacity to consent on his own behalf to any surgical, medical, or dental procedure or treatment where he/she is capable of understanding the nature and possible consequences of the procedure/treatment (latter unless overruled by court)
- If a child (i.e. under 16) lack’s capacity you should ask for the parent’s consent (same as rest UK)
- > 16 years old lacking capacity treated as an adult with incapacity
- Parents cannot authorize a treatment a competent young person has refused (should seek level advice)
ENGLAND (Statute and Common law basis)
-16 year old and over can consent to treatment
-Children under 16 may have capacity to consent depending on their maturity and ability to understand what is involved.
-BUT parents can consent on behalf of a 16-17 year olds in their best interests
AND 16-17y old can be treated without parental consent although their views might be important to assess best interests
-Law of overriding young people’s competent refusal is complex
-If a child (i.e. under 16) lack’s capacity you should ask for the parent’s consent
Define Gilick competence and Fraser guidelines.
- Gilick competence seeks to determine whether a child (under 16) has a capacity to consent.
- Fraser guidelines specifically relate only to contraception and sexual health (i.e. specific issue of giving contraceptive advice and treatment to those under 16 without parental consent).
What can a competent child’s consent to treatment be overruled by ?
Court, over-riding duty to act in best interests of a child, children should be involved as much as they are able.
(not parents)
Can a doctor act if they believe the parents of a young person, or an adult, without competence are not acting in the patient’s best interests ?
Yes.
Discuss with your seniors, seek advice of local child protection team (for young people) or protecting vulnerable adults team (for adults with incapacity)
Which information must the patient be provided (as long as they want/need it) for the patient’s consent to be valid ?
- Diagnosis and prognosis
- Any uncertainties about diagnosis and prognosis, including options for further investigations
- Options for treating or managing the condition, including the option not to treat
- Purpose and what it will involve
- Possible risks, benefits, burdens, likelihood of success for each option
- Right to seek a second opinion
- Bills they have to pay
- Conflicts of interest that you or your organisation may have
What is the proper course of action if a patient does not want information ?
♦ Explore reasons why patient does not even want to know the basic information and explain why it is important
♦ Respect wishes where patient do not wish to have information but provide basic information needed to make a decision
♦ Try to overcome obstacles to providing information
1) Pressure on a doctor’s time: for instance by getting another member of the healthcare team to speak to the patient, patient information leaflets, advocacy services, support groups
2) Special needs of the patient
Briefly summarise the Sidaway case and explain how it affected the Bolam principle.
The claimant suffered from pain in her neck, right shoulder, and arms. Her neurosurgeon took her consent for cervical cord decompression, but did not include in his explanation the fact that in less than 1% of the cases, the said decompression caused paraplegia. She developed paraplegia after the spinal operation.
She sued.
The Sidaway case extended the Bolam principle to the quality of information provided to a patient about a given treatment.
i.e. You could not sue your doctor for failing to tell you about risks if other reasonable doctors would not have told you either.
What is the GMC guidance on the extent to which one should go about telling patients about side effects ?
The amount of information about risk that you should share with patients will depend on the individual patient + what they want or need to know.
You must tell patients if an investigation or treatment might result in a serious adverse outcome, even if the likelihood is very small”
What factors should a doctor take into consideration when deciding whether or not to tell the patient about a particular side effect.
- Incidence of the risk
- Nature of the risk
- Effect it would have on patient’s life
- Importance place by patient on achieving the benefits of the procedure
- Alternative treatments available (and associated risks)
Why must the provision of information to the patient to obtain consent involve a dialogue ?
To ensure that the patient understands the seriousness, anticipated benefits and risks, reasonable alternatives. (because patient may place particular importance on a particular risk he/she does not know is involved with the operation)
