3. consent

What happens if you don’t get consent

may count as a crime.

battery or negligence

What constitutes as battery?

• performing the wrong operation

• ignoring a withdrawal of consent

• ignoring a specific prohibition against treatment

what constitutes valid consent

• patient has capacity to consent to intervention

• patient’s appropriately informed

• given voluntarily

if the person lacks capacity, what should the actions be done like

in best interest of the patient

2 stage test to find capacity

1: is the patient suffering from an impairment of, or disturbance in the function of, the mind or brain?

2: does the disturbance/impairment make a person unable to make a decision for themselves at the time

function test to confirm competance

1. patient understands information relevant to the decision

2. retains information

3. uses or weighs up the information as part of the process

4. communicate their decision

if the person doesn’t have consent, what’s a doctor’s duty

duty to consult others (family/friends, anyone relevant to indicate what the person may want)

what should be documented

EVERYTHING, in case it heads to court

what should especially be documented

• how the decision about best interests was reached

• what the reasons for reaching the decision were

• who was consulted

• what particular factors were taken into account

what’s IMCA

those who can stand in for the patient to make the decision for themselves

what happened w Montgomery v Lanarkshire health board

• she was expecting a baby, and was diabetic

• diabetic woman can have larger babies, w weight concentrated on shoulders instead of the head

• ~10% chance of kid having shoulder dystocia

• she wasn’t told abt this bc the risk was small and “if everyone was told, everyone would do a c-section. that’s a no no apparently”

What came from the Montgomery v Lanarkshire Health Board case

the reasonable patient test

what’s the reasonable patient test

the doc ensures the patient’s aware of any material risks involved or any alternative treatments

When can information be withheld?

1. if the patient doesn’t wanna know

2. if telling them would be v detrimental to the patient’s health

3. in circumstances of necessity

what are circumstances of necessity

• can’t talk to patient, but treatment’s necessary

• best interests

• documented decision

• in emergency

what’s a limit to necessity

imminence and severity of the threat is relevant to decide if an unlawful medical practice is justified or not.

what should a doctor’s decision to a patient be based on

1. nature/severity of condition

2. how quickly the decision should be made

3. impact of outcomes on the patient

4. what’s known about the patient, the condition and options for treating/managing it

5. nature of consultation

What do include when discussing benefits or harms

1. risks of harm or benefits that anyone would wanna know, common and not

2. effect of the patient’s clinical circumstances on the probability of benefit or harm occuring

who’s responsible for obtaining consent

the doctor performing the procedure

if a student’s doing smth, consent should be delegated to…

someone in the MDT

what does that someone in the MDT have to be able to do

• suitably trained

• sufficient knowledge of benefits and risks

• necessary communication skills

• competent to carry out procedure

Standard consent forms

1. Adults or children w mental capacity

2. parental consent to treatment/investigation of a child or young person

3. procedure specific consent form

4. adults lacking mental capacity

What happened in the Gillick v West Norfolk & WIsbech AHA case

• contraceptive services were to be more readily available for ppl under 16, and they can get it without parents’ consent sometimes

• Mrs gillick had daughters under 16, and wrote to the Area Health authority to stop medical staff from giving contraceptive advice to kiddies under 16

• she lost eventually

What came from the Gillick v West Norfolk & Wisbech AHA case

parents can decide for the kid till the kid reaches good enough understanding to make their own mind up

So what’s the general rule w kiddies and consent

if they have capacity, kiddies can consent

if kiddies can’t consent

consent should be given by the person w parental responsibility, or the court

no matter their capacity, what should doctors do w children’s wishes

• listen and take into account what they say abt things that’ll affect them

• respect their decisions & confidentiality

What’s Gillick competence

a test seeing if a kiddie under 16 has the capacity to make a relevant decision

What do you assess w a child vs an adult to check capacity

literally the same stuff

who tends to have parental responsibility

• birth mother

• married fathers

• those on the birth certificate

• adopted parents

• legal guardian

• ppl w a residence order

what if the kid has no one w parental responisbility

local authority takes control

how does divorce or marital separation affect parental responsibility

it doesn’t.

what if someone w parental responsibility wants to see records

• they’re allowed to ask

• if child’s competent to make their own decisions, get consent from the kid

• if not, show them records so long as it doesn’t go against bets interests of the child