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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?
- Understand and retain relevant information
- Use and weigh that information to make a decision
- 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
- The purpose of the intervention, its nature, and purpose and why it is being proposed
- The main benefits/ risks and alternatives
- 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?
- Intervention must benefit the adult
- Such a benefit cannot reasonably be achieved without the intervention
- Take account of past and present wishes
- Consult with other relevant persons
- 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?
- Likely to have a mental disorder
- Significantly impaired decision-making ability regarding treatment due to mental disorder
- Detention in hospital is necessary as a matter of urgency to determine what treatment is needed
- The risk to health, safety, or welfare of the person or the safety of others
- Making arrangements for s44 would involve undesirable delay
What are your criteria for short term detention under the
mental health act?
- Likely to have a mental disorder.
- Dignificantly impaired decision-making ability regarding treatment, due to mental disorder
- Detention in hospital is necessary for assessment of treatment
- Risk to health, safety or welfare of the person, or risk of safety of others
- 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
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