Capacity and Consent for MRCPsych Exams

Capacity and Consent

What is the definition of consent?

Consent is permission for something to happen or agreement to do something consent is to give permission for something to happen

What do you need for valid consent?

Given freely without duress or coercion legally capable of consenting cover the intervention/procedure it must be informed it has to endure the time needed for treatment. 

If a patient consents to treatment can they then change their mind?

Yes, either before treatment or at any point during treatment. 

What information do you have to portray to the patient when trying to get consent?

What the treatment consists of the main beneficial effects, risks, and unwanted side effects of treatment.

What sort of additional aids could you use in trying to obtain consent?

Written/ visual aids translators’ friends/relatives time to reflect- especially if a large treatment

What is capacity?

Capacity is the ability to make a decision

What is the capacity to consent like in delirium?

As delirium is a fluctuating illness at some points during the day, they will have the capacity and at other points, they will not.

Once someone has the capacity is it definite that the individual has full capacity?

False- you can have the capacity to make a decision about one thing but not have the capacity for another decision capacity can also fluctuate over time

If consent is needed for a treatment who should take the consent?

The person conducting the treatment/procedure

What 3 things must you be able to do to have capacity?

1. Understand and retain relevant information
2. Use and weigh that information to make a decision
3. Communicate that decision

When can you use the Adults with Incapacity Act?

If the person is incapable of acting or making decisions communicating decisions, understanding decisions, or retaining the memory of decisions

What is the general overall reason for using adults with incapacity act?

In relation to any matter by reason of mental disorder or of inability to communicate because of physical disability

What can cause the disability that would require the use of the adults with incapacity act?

Mental disorder or physical disorder

What sort of things can a patient not be able to do for you to use the adults with incapacity act?

They aren't able to understand 

1. The purpose of the intervention, its nature, and purpose and why it is being proposed
2. The main benefits/ risks and alternatives
3. Consequences of not receiving an intervention

Should we assume capacity?

We should assume capacity until proven otherwise.

What is the age for most people being thought of as having capacity?

Age 16 and onwards

You always must have the legal documentation and paperwork in order before you use the mental health act or Adults with Incapacity Act--true or false?

This is not true. In an emergency deal with the situation first and then deal with the paperwork

What are the principles of the adults with incapacity act?

1. Intervention must benefit the adult
2. Such a benefit cannot reasonably be achieved without the intervention
3. Take account of past and present wishes
4. Consult with other relevant persons
5. Encourage the adult to use residual capacity

Should you move to use the Adults with Incapacity Act quickly?

No, you should try and get capacity, and then if you can’t then use the Adults with Incapacity Act.

What are the main things you need to know about the Adults with Incapacity Act?

Section 47 certificate of incapacity power of attorney guardianship

What is the role of the Adults with Incapacity Act section 47 certificate?

Authorize practitioner to provide reasonable interventions related to the treatment authorized

Does section 47 certificate of the Adults with Incapacity Act allow you to use force?

No, it does not authorize you to use force unless its immediately necessary and only for as long as necessary

Does the AWI section 47 certificate allow you to transport an individual?

No, you can’t move the patient to the place of treatment

If you have an adult that needs to be transported to a place of care under the AWI section 47 certificate how can you move them to a place of treatment?

Emergency order from the mental health act or get a warrant to move them

The bottom line when would you use AWI section 47?

Use to authorize the treatment of a physical disorder in someone without the capacity to consent to that treatment

Who fills out the section 47 AWI form?

The most senior treating clinician

When will someone appoint a power of attorney?

Whilst they still have the capacity.

What roles do the power of attorneys have?

They can act in decisions relating to their financial or health welfare

What is the point in a power of attorney?

It is a person that the patient trusts to help make decisions for them in case they lose capacity at some point. 

Can you only have one power of attorney?

No, you can have more than one. 

Who applies for guardianship?

One or more individual or local authority. 

Who grants guardianship?

The sheriff. 

What does the guardianship there for?

To watch out for your welfare or financial status

What is the overall reason for guardianship?

When the person required someone to make specific decisions on their behalf over the long term, but they have now lost capacity so cannot appoint a power of attorney. 

What powers does a welfare guardian have?

They can have a role in voicing the treatment that the patient will get but they cannot place the adult in hospital for treatment of a mental disorder against their will.

What happens if the patient does not comply with the wishes of the welfare guardian?

The sheriff can issue a compliance order. 

If you have a patient with a mental illness that needs to be placed in the hospital what should you use to do this

Use the Mental Health Act. 

Is this true that a welfare guardian can make decisions on a patient’s behalf but cannot enforce them?

TRUE

What is the role of the mental health act?

It allows for the treatment of mental disorders or the physical consequence of a mental disorder in someone without the capacity to consent to treatment

What are the 3 different sections of the mental health act

Emergency detention certificate short term detention certificate compulsory treatment order

What are the criteria that you have to meet for emergency detention under the mental health act?

1. Likely to have a mental disorder
2. Significantly impaired decision-making ability regarding treatment due to mental disorder 
3. Detention in hospital is necessary as a matter of urgency to determine what treatment is needed
4. The risk to health, safety, or welfare of the person or the safety of others
5. Making arrangements for s44 would involve undesirable delay

What are your criteria for short term detention under the mental health act?

1. Likely to have a mental disorder.
2. Dignificantly impaired decision-making ability regarding treatment, due to mental disorder
3. Detention in hospital is necessary for assessment of treatment 
4. Risk to health, safety or welfare of the person, or risk of safety of others
5. Cannot be treated voluntarily

What controls whether a young person is able to consent to treatment?

Are they able to make decisions through understanding them and weighing the options?

At what age in Scotland are you presumed to have capacity?

16

Can you give your own consent under the age of 16?

Yes, if deemed to have capacity using Gillick competence

What does a young person have to be able to do to be deemed as having capacity?

Understand the nature, purpose, and consequences of investigation or treatment understand the consequences of not having treatment understand, retain, use and weigh this information and communicate their decision

Do you want the parents involved in capacity and consent with children?

Yes, as far as possible.

What do you do if you have a child under the age of 18 that doesn't have capacity?

You can ask one parent for consent - do not need both if both parents disagree then seek legal advice

Is there a lower age limit for the mental health act?

No

If you have to force treatment on a child is it better to use the mental health act or parental consent?

Mental health act - you are more protected and the relationship between carer and patient is still intact

When in particular in children would you want to use the mental health act as backing over parental consent?

If you must use force if you have to use IM medication nasogastric feeding and electroconvulsive therapy

Open Ended Questions

An open-ended question is one that puts the least restrictions over the answer to a select option-list. For example, an open-ended question to assess the thoughts would be:

What do you think about most often?

You can already notice, it is impossible to ask an absolute-open ended question. 

For the purpose of the Research Workshop, the College of Physicians and Surgeons states: 

Open-ended questions elicit detailed responses and provide no preselected options. These types of questions are the hallmark of qualitative research.  

Also, learn the advantages of open-ended questions.