1. Capacity for Consent - How Much Do We Know About It? Kate Evans Specialist Registrar in Emergency Medicine Derriford Hospital, Plymouth

2. Outline Background Study methods Results Discussion Conclusions

3. Why did I look at this? Working in ED Masters in Medical Law Mental Capacity Act Previous study

4. Capacity What does this mean? Why this is important to us? NICE “All healthcare professionals who have contact, in the emergency situation, with people who have self- harmed should be adequately trained to assess mental capacity and to make a decision about when treatment and care can be given.”

5. Re C In order to make a decision a patient must be able to Take in and retain information Believe it Weigh that information, balancing risks and needs Mental Capacity Act

6. Study methods doctors (42), nurses (21) and ambulance staff (23) in ED in Birmingham

7. Questionnaire What three points would you look for in assessing one’s capacity to give valid consent? Take in and retain information Believe it Weigh that information, balancing risks and needs

8. Questionnaire If a competent adult refuses medical treatment that you are proposing can you still treat them under common law? NO

9. Questionnaire If someone is deemed incapable of signing a consent form for a procedure, is it legally necessary to get a relative to sign it instead? NO

10. Questionnaire Should the Mental Health Act be used to treat physical illness when someone with a mental disorder is refusing treatment ? NO

11. Results What three points would you look for in assessing one’s capacity to give valid consent?

12. Results If a competent adult refuses medical treatment that you are proposing can you still treat them under common law?

13. Results If someone is deemed incapable of signing a consent form for a procedure, is it legally necessary to get a relative to sign it instead?

14. Results Should the Mental Health Act be used to treat physical illness when someone with a mental disorder is refusing treatment?

15. Discussion We are leaving ourselves open to criticism and legal action It is not always easy – Varies for the decision being made – Altered by drugs, alcohol and emotional distress

16. What should we do? Most patients will consent to treatment If patients don’t consent then an assessment of capacity must be made – If the patient has capacity then their decision must be respected – If the patient lacks capacity then they can be given treatment which is in their best interests – If there is doubt err on the side of caution

17. Study conclusion More training is needed!!

18. Any Questions