Consent by a diabetic patient who appears incompetent

A 55-year old woman with diabetes is diagnosed to have gangrene on both feet. She was brought to the hospital. She told the doctor the she is feeling fine and she has no medical problems. Can she give consent for the amputation of both legs?

Comments

Anam Najam no

Hajira Mehboob No she needs psychological treatment...

Valeed Ahmed The patient appears incompetent as she says she is fine and there is nothing wrong with her, so her consent is not acceptable

Hospitalizing autism patient who is not resisting

You are working in the UK as a consultant psychiatrist. A 20 year old Patient is suffering from autism. You think he should be admitted to autism treatment center. Guardians are not willing to hospitalize him although the patient himself is not actively refusing to be hospitalized. What is the most appropriate step to take ?

Admit him to the hospital
Treat on out patient basis
Refer to best interests assessor

Comments

Bournewood Gap

An adult patient who was suffering from autism was admitted to bounwood hospital because he by himself was not resisting to be admitted although his carers were not willing for this. This case indicated a “gap” in the law i.e. Failure to protect an individual’s liberty if he can not resist.

Deprivation of liberty safeguards

Bournewood case lead to deprivation of liberty safeguards act in 2007, according to which such patients will be asses by a ‘best interests assessor’ before such action is taken to make sure it is in the best interest of the patient. The act itself is complicated.

Exception to the rule of consent to treatment

Which of the following cannot be considered as an exception to direct informed consent?
A. Waiver
B. Detention under mental health act
C. Emergencies where full information cannot be given
D. Incompetent patient
E. Passively compliant patient

Comments

Valeed Ahmed The answer is E, passive compliance is not an exception, rather an implied consent is.

The situations in which explicit consent is not required are :

Implied consent given
Necessity (harm likely, competency doubted)
Emergency 

Mentally ill patient needs medical treatment

An adult patient is severely depressed refuses get treated for HCV infection. How should this patient be dealt with ?

First treat depression and then for HCV
Treat for HCV and depression without consent
Obtain a court order to treat for both

Comments

Anam Najam First treat depression and then for HCV

Waleed Ahmed When a mentally ill patient refuses consent to medical treatment, the steps are

Step 1 treat the psychiatric condition

Step 2 treat the medical condition
If psychiatric condition can not be treated, consider legal action e.g. Court order or consent from relative

Angel's Dua agreed

Implied consent

You are about to check a patients Blood pressure. As you Reach the bedside and open your BP apparatus, the patient extends her arm to let you check her BP although you have not asked for a consent yet. What is the best next step

Take verbal consent
Check her BP without asking

Comments

 Asma Zafar A

  Immo Mani Check without asking

 Sarmad Mushtaq A

 Nazia Tanveer B 

 Salma Sultan Obviously without asking

 Valeed Ahmed Extending her arm when she sees a bp apparatus is implicit consent which obviates the need for an explicit consent. The other exceptions for explicit consent are emergency and neccessity (harm likely, competency in doubt)

 Misbah Mustafa Means explicit consent should still be taken right?

  Valeed Ahmed No. It is not needed.

 Inam Ul Haque Masood Her extending the arm so that you can take blood pressure is a sign of consent and I believe that taking verbal consent is not mandatory

Competency of the mother to consent for children

A 25-year old woman developed postpartum psychosis. The newborn developed cyanosis due to congenital heart disease. The newborn needs cardiac surgery. Surgeon discussed the procedure with the mother. She understood the procedure. Can she give the consent ?

Comments

 Asma Zafar Yes

 Immo Mani Yes

 Annie Hassan No

 Sarmad Mushtaq No

 Valeed Ahmed The pre-requisites for consent are that the patient (or the other person in charge) must fully and clearly understand the condition and its treatment., be competent and agree to the consent voluntarily. As the patient understood everything, so she her consent is acceptable. One person may be competent for one decision and be incompetent for another one. In this case the patient is competent as she was able to understand the decision

 Anam Najam logically correct laikin yaqeen nhi a raha :-/

 Valeed Ahmed Please read the consent topic in oxford once more. There is a similar statement

 Valeed Ahmed

 Anam Najam Thanks :)

Consent validity by minors

A 17-year old boy came to a surgeon for bilateral vasectomy. He is the father of one child and does not want to have any more children. He does not want to tell his girlfriend and parents. He lives with his parents. What should a surgeon do in this situation?

Comments

 Anam Najam perform the procedure

 Asma Zafar Tell him both the advantages and disadvantages of performing the procedure and make him to write cost benefit analysis to realize the situation

 Ali Al Shikh Consent is necessary 

But first he has to know the cause of this surgery ( may has psychological cause)

 Valeed Ahmed He is a minor as yet and may not understand the implications of such a serious decision. The surgeon should refuse the vasectomy and offer other less harmful alternatives.

 Anam Najam Isnt it so that one can give consent if one is above 16 yrs of age?

 Valeed Ahmed Not in every case.

 Ghada Hegazy He's a minor living with his parents. The guardian must consent. The only exception is if he's living in a state that allows for partial emancipation due to birth control, i.e. He can make that choice. However, the surgeon should offer some alternatives to the procedure.

  Inam Ul Haque Masood Minors can not consent

 Nirmal Zahra Minors cannot give consent...the parents or guardians are to be consulted here. The client should be made aware of this. Also, give him other better options.

 Angel's Dua i think before performing surgery it is important to know y he wants this and for that sake he should be referred to psychologist for detail evaluation and should be explained with pros and cons of the surgery may b through psychological investigation u reach the real problem which could be solved other wise

Legal capacity to consent

A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with the patient who understood the procedure. Can the patient give consent?

Anam Najam yes

Like · Reply · July 2 at 10:44pm

Asma Zafar No

Like · Reply · July 2 at 11:06pm

Immo Mani Yes

Like · Reply · July 3 at 12:39am

Valeed Ahmed Yes, as already explained, if someone understands the procedure, agrees to it and be competent, he can give the consent

Like · Reply · 2 · July 3 at 2:49pm

Angel's Dua yes since he is in good state of health who can understand the procedure so he can also give consent

Bournewood gap and deprivation of liberty

Bournewood Gap

An adult patient who was suffering from autism was admitted to bounwood hospital because he by himself was not resisting to be admitted although his carers were not willing for this. This case indicated a "gap" in the law i.e. Failure to protect an individual's liberty if he can not resist. 

Deprivation of liberty safeguards 

Bournewood case lead to deprivation of liberty safeguards act in 2007, according to which such patients will be asses by a 'best interests assessor' before such action is taken to make sure it is in the best interest of the patient. The act itself is complicated. 

Steps to take when consent to medical treatment is refused

Patient refuses consent to medical treatment. The doctor must now confirm two things. One is patient's competence and the other is ? 

1. Outcome of the condition without treatment 


2. Age of the patient


3. Voluntary nature of the decision  

Answer: 3, the steps are :

1. Check competence of the patient 


2. Ensure that the patient is not under the influence of relatives but rather has made a voluntary decision


3. Check the patient's concenrs and understanding of the situation


4. Explain everything once again


5. If still refuse, it is there right to do so. 

Steps to take when a patient fails to collaborate with consent

• Seek to re-establish the consent


• Offer additional help


• Do not threaten to reduce help

What is consent ?

Autonomous authorization of a medical intervention by individual patients 

Pre-requisites of obtaining consent from a patient

The patient should ACU

• Agree 


• Be competent 


• Have clear and full understanding of the situation 

Steps to take when a mentally ill patient refuses medical treatment

An adult patient is severely depressed refuses get treated for HCV infection. How should this patient be dealt with ? 

1. First treat depression and then for HCV


2. Treat for HCV and depression without consent


3. Obtain a court order to treat for both

The answer is 1, Here are the steps: 

• Step 1 treat the psychiatric condition


• Step 2 treat the medical condition


• If psychiatric condition can not be treated, consider legal action e.g. Court order or consent from relative

Reasons for lacking capacity to give informed consent

MAL

• Mental disorder


• Age being young


• Learning disability

Situations in which explicit consent is not required

One of these cannot be considered as an exception to direct informed consent? 

• A. Waiver 


• B. Detention under mental health act 


• C. Emergencies where full information cannot be given 


• D. Incompetent patient 


• E. Passively compliant patient

The answer is E, passive compliance is not an exception, rather an implied consent is. 

The situations in which explicit consent is not required are : 

• Implied consent given


• Necessity (harm likely, competency doubted)


• Emergency 

Steps to take when incompetent patients refuse consent to medical treatment

• The doctor decides in the best interests of the patient. 


• Careful record should be made


• Other relevant medical staff should be consulted