1. VALUES: A SCENARIO Adam Pearce & Emily Matthews

2. Values: A Scenario As the orthopaedic registrar on-call, you are bleeped to see a patient in A&E

3. Values: A Scenario Mrs Bump, a 75 year-old lady has fallen over on some ice and sustained a #NOF

4. Before meeting the patient, you read her notes and discover she was diagnosed with Alzheimers Disease 4 years ago. You recommend surgery and need to obtain consent. Values: A Scenario

5. As the orthopaedic registrar on-call, you are bleeped to see a patient in A&E. Mrs Bump, a 75 year-old lady has fallen over on some ice and sustained a #NOF. Before meeting the patient, you read her notes and discover she was diagnosed with Alzheimers Disease 4 years ago. You recommend surgery and need to obtain consent. 3 minutes to discuss how you will approach gaining consent for surgery

6. Values: A Scenario Valid consent CapacityInformation Voluntariness (free from coercion) What THREE things are required for valid consent?

7. What FOUR things are required to demonstrate capacity? Understand info Retain infoWeigh-up Communicate decision Capacity N.B. Assume Mrs Bump has capacity unless proven otherwise

8. Values: A Scenario Valid consent CapacityInformation Voluntariness (free from coercion) What information is required?

9. Information Broad info Risks, benefits, alternatives Defence against BATTERY Defence against NEGLIGENCE

10. Values: A Scenario You decide Mrs Bump does NOT have capacity to consent to the surgery. What next?

11. Assess capacity 1. Understand Retain Weigh-up information Communicate decision

12. Assess capacity Facilitate a capacitous decision if possible 1. 2. Communication aids Time of day Remove sedation Understand Retain Weigh-up information Communicate decision

13. Assess capacity Facilitate a capacitous decision if possible Does patient have a valid advance refusal? 1. 2. 3. Communication aids Time of day Remove sedation Understand Retain Weigh-up information Communicate decision Over 18 years of age Relevant circumstances Patient not done anything inconsistent with directive For refusal of life-sustaining treatment Written Signed witnessed

14. Assess capacity Facilitate a capacitous decision if possible Does patient have a valid advance refusal? Does patient have someone with lasting Power of Attorney? 1. 2. 3. 4. Communication aids Time of day Remove sedation Understand Retain Weigh-up information Communicate decision Over 18 years of age Relevant circumstances Patient not done anything inconsistent with directive For refusal of life-sustaining treatment Written Signed witnessed Can only give or refuse life-sustaining treatment if this was specifically stated

15. Assess capacity Facilitate a capacitous decision if possible Does patient have a valid advance refusal? Treat in patients Best Interests (another topic in itself!) Does patient have someone with lasting Power of Attorney? 1. 2. 3. 4. 5. Communication aids Time of day Remove sedation Understand Retain Weigh-up information Communicate decision Over 18 years of age Relevant circumstances Patient not done anything inconsistent with directive For refusal of life-sustaining treatment Written Signed witnessed Can only give or refuse life-sustaining treatment if this was specifically stated

16. Values: A Scenario If the patient were a 15 year- old child, Is anything different?

17. Values: A Scenario Adults over 16 are presumed to have capacity, until proven otherwise Children under 16 are presumed to lack capacity, unless proven otherwise Is the child GILLICK COMPETENT ? FRASER GUIDELINES - contraception

18. Values: A Scenario You assess the child as NOT being Gillick competent. Who do you look to for consent?

19. Values: A Scenario Person with parental responsibility, (who must have capacity) Mother Married father Unmarried father to a child born after 1 st December 2003 and named on birth certificate Adoptive parents Person with Parental Responsibility Order e.g. civil partner, step-parent Local Authority for a child in care If the parents are divorced, can the father still give consent? Yes, once parental responsibility is acquired, it remains even after divorce

20. Values: A Scenario What if the parents disagree with each other on the course of treatment? Legally only consent of one parent is needed BUT, Good practice to: -Work with both parents and if possible informally resolve the dispute -Involve child in the decision-making process -Act in childs best interests

21. http://www.gmc-uk.org/guidance/20473.asp#Case GMC interactive case studies - useful for revision Values: A Scenario