CONSENT Establishing consent is fundamental to respect for patients rights. It is a legal obligation.
WHAT IS CONSENT Consent is matter of whether a person has mental capacity to foresee the likely consequences of a decision.
ESTABLISHING CONSENT Need to inform the patient in a way that is clear easy to understand. Taking to account any communication difficulties. Take all steps to reasonably facilitate a decision. Consent is time and decision specific.
FLUCTUATIONS Be aware that the ability to consent may fluctuate. Do not make presumption simply based upon a disability.
THE LEGAL TEST The two-stage test of capacity: 1.Is there an impairment of, or disturbance in the functioning of the person’s mind or brain? 2. If so, is the impairment or disturbance sufficient to cause the person to be unable to make that particular decision at the relevant time ?
THE FUNCTIONAL TEST Can the person Understand? Retain? Use or weigh up? Communicate?
UNDERSTANDING THE INFORMATION reasonably understand options and why they are being proposed. What are the implications taking or not taking prescribed medication
RETAINING INFORMATION RELATED TO THE DECISION The information needs to be retained long enough for the person to both understand the question and consider and weigh up the options. A good way of testing this is asking the person to paraphrase the decision and what the options are. Retain Can you remember what the choices are?
WEIGHING up? Demonstrates an awareness of the risks, benefits and implications of each choice. Enters into meaningful discussion about the choice? reasonably foresee the likely consequences of the decision.
WEIGHING UP pros Positives benefits Option 1 Option 2 cons Negatives risks pros Positives benefits Cons Negatives Being able to reason and consider the likely consequences. risks
COMMUNICATE Inform you of their choice by what ever means they can.
Advance decisions any person with capacity to so can make an advanced decision. For example they cam make an advanced decision to refuse medical treatment.
EMERGENCIES You will be legally protected if you have made a balance probability decision on capacity You can act without formally assessing capacity
WHEN A PERSON LACKS CAPACITY If a person lacks capacity to make a decision, then a best interests decision is made on their behalf. This is made by a decision maker (relevant professional)
DETERMINING BEST INTERESTS Even if a person lacks capacity it is still important to take their wishes and feeling into account Consult with other professional and family IMCA (if no family) serious medical treatment
DETERMINING BEST INTERESTS Having established wishes and feelings take into account the advantages disadvantages of the options. Referred to as a balance sheet
BALANCE SHEET pros Positives benefits Option 1 Option 2 cons Negatives risks pros Positives benefits Cons Negatives weighing the risks and benefits to make balance of probability decision risks
COVERT MEDICATION Can the person consent? If no it is in the persons best interests?