Consent, capacity, confidentiality and children Flashcards
(48 cards)
What is consent?
The law requires permission from a patient before treatment can occur -> this is consent
What is consent required for?
It is required for any form of medical management – from taking a history, conducting an examination through to interventional treatments such as operations.
What do patients have a right to do if they do not consent?
They have the right to refuse consent to medical treatment -> this should not adversely affect patient care
What happens if a doctor acts without consent of a patient?
they may have committed the following offences:
Criminal offence -> assault, battery, common assault (combo of both assault and battery)
Civil action from patient -> claim for damages
What happens if a doctor acts without consent of a patient?
they may have committed the following offences:
Criminal offence -> assault, battery, common assault (combo of both assault and battery)
Civil action from patient -> claim for damages
Exceptions to asking for consent?
- Genuine medical emergency whereby obtaining consent would lead to damage to a patient and there is no time to ask
- Implied -> implied via actions e.g. lifting up top when asking permission to examine
- Waiver -> patients waive consent as they don’t want to know the details and just want treatment
-Acting in patient’s best interest -> patient may not be able to partake in the discussion e.g. unconscious or lack capacity to consent
Why should you be careful of waiving of consent?
Not okay for relative of patient to attempt waiving of consent -> okay for patient
Doctors must not put themselves in position of agreeing to such a waiver without good reason
What is valid consent?
A competent person that understands the nature of the treatment based on information in ‘broad terms’ without coercion who then gives permission
What is a competent person?
Understand the information -> the info relevant to the discussion
Retain the information.
Use the information to make a decision.
Communicate the decision.
Consent presumptions for adults?
Adults (from age 16 onwards)
- Are assumed to have mental capacity to make a decision regarding treatment.
- Unless there is contrary evidence.
Consent assumptions for children?
Children (less than 16)
- Are assumed to NOT have mental capacity to make a decision regarding treatment.
- Unless there is contrary evidence.
How much information is a doctor expected to provide for valid consent?
The current legal position is that a doctor would be expected to provide the information that their specific patient would reasonably want to know. This underlies the importance of shared decision making, so that the doctor understands the impact of a proposed procedure or treatment on their patient
What might make consent from a patient invalid?
If the consent was provided within a coercive environment
If refusal of consent led to death, would a competent individual have the right to refuse?
A competent individual has an absolute right to refuse treatment even if that refusal may lead to severe and permanent harm or death. The refusal may be based on a good reason, an unwise reason or no reason at all. Provided the refusal is competent, informed and voluntary it MUST be respected.
When is the refusal of consent legitimate?
if a patient who fills the criteria for competence when given information in broad terms, refuses and they are not under coercion, then they have refused the treatment
What would you do if an adult lacked capacity but needed life saving surgery?
Proceed with surgery, provided it is in patient’s best interests -> asking relatives might help ascertain best interests but is not legal grounds for surgery
Who can consent on behalf of an adult who lacks capacity?
No one can consent on behalf of an adult who lacks mental capacity unless they have been granted specific legal authority by the Court of Protection to do so.
Exceptions to keeping confidentiality?
- implied consent
- with consent
- required by law
- in wider public interest
Describe implied consent with regard to exception to breach of confidentiality?
IMPLIED CONSENT BY PRESENCE
Rather than express consent (patient says “yes” orally or in writing) we imply that the patient consents to us telling the wider team about their condition, through them being in hospital and realising that other people will be looking after them too.
Describe the conditions for breaking confidentiality with regard to express consent?
Must be express -> from patient and not others involved in their care
How much information to be divulged?
To whom?
Most relatives don’t have rights
When do relatives have a right to know with regard to patient confidentiality?
Unless a parent of a child who is not Gillick competent, relatives do not have a right to know in most cases.
In situations of a patient who lacks competence to make a decision about health care, next of kin now have a right to be consulted where practical to do so.
Describe the conditions for breaching confidentiality with regard to it being required by statute?
Examples requiring a breach include.
- Notification of Death.
- Notification of Termination.
- Treatment of Drug addict with specified drugs.
- Notifiable Infectious Disease.
In these cases permission of the patient is not required, and the relevant authority must be informed.
Describe the conditions required for breaching confidentiality with regard to assisting the police?
Exceptions:
- Under a warrant from a circuit judge.
- To aid police request in identifying drivers suspected of offences.
- To aid police in all matters with suspected terrorist patient.
the Department of health states that ‘theft, fraud and damage to property’ would not usually provide reasonable justification for breaching confidentiality.
Describe the conditions required for breaching confidentiality with regard to assisting the police?
Exceptions:
- Under a warrant from a circuit judge.
- To aid police request in identifying drivers suspected of offences.
- To aid police in all matters with suspected terrorist patient.
the Department of health states that ‘theft, fraud and damage to property’ would not usually provide reasonable justification for breaching confidentiality.
