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

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

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 

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

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

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 :)

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

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 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. 

Patient refuses consent to medical treatment. The doctor must now confirm two things. One is patient's competence and the other is ?  Outcome of the condition without treatment  Age of the patient Voluntary nature of the decision   Answer: 3, the steps are : Check competence of the patient  Ensure that the patient is not under the influence of relatives but rather has made a voluntary decision Check the patient's concenrs and understanding of the situation Explain everything once again If still refuse, it is there right to do so. 

Seek to re-establish the consent Offer additional help Do not threaten to reduce help

Autonomous authorization of a medical intervention by individual patients 

The patient should ACU Agree  Be competent   Have clear and full understanding of the situation 

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 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

MAL Mental disorder Age being young Learning disability

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 

The doctor decides in the best interests of the patient.  Careful record should be made Other relevant medical staff should be consulted