Consent to Examination or Treatment Policy - Nottinghamshire ...

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Consent to Examination or Treatment – 1.03 • there has been a significant lapse of time between the form being signed and the proposed procedure being undertaken; • new information becomes available regarding the proposed intervention (for example, new evidence of risks or new treatment options); • the patient’s condition has changed significantly in the intervening period between the time when consent was sought and when the intervention is undertaken. 11.6 When confirming the patient’s consent and understanding, it is advisable to use a form of words which requires more than a yes/no answer from the patient: For example beginning with “tell me what you’re expecting to happen”, rather than “is everything all right?” 11.7 While administrative arrangements will vary, it should always be remembered that for consent to be valid, the patient must feel that it would have been possible for them to refuse, or change their mind. It will rarely be appropriate to ask a patient to sign a consent form after they have begun to be prepared for treatment (for example, by changing into a hospital gown), unless this is unavoidable because of the urgency of the patient’s condition. 11.8 The patient’s consent may be obtained by post and this gives the patient time to read and reflect on the consent form and information provided. However, any person carrying out a procedure on a patient must ensure that, immediately before the procedure, the patient has understood the information and that they still give their consent. If the patient has queries or concerns he or she must be given time to consider any additional information. 11.9 Whatever the context in which medical decisions are made, you must work in partnership with your patient to ensure good care. In so doing, you must: • listen to patients and respect their views about their health • discuss with patients what their diagnosis, prognosis, treatment and care involve • share with patients the information they want or need in order to make decisions • maximize patients’ opportunities, and their ability, to make decisions for themselves • respect patients’ decisions 12.0 PROCEDURE TO FOLLOW WHEN PATIENTS LACK CAPACITY TO GIVE OR WITHHOLD CONSENT 12.1 The Mental Capacity Act 2005 provides a statutory framework to empower and protect vulnerable people who may not be able to make their own decisions. It applies to persons over the age of 16 (with some exceptions relating to creation of Advance Decisions and Lasting Powers of Attorney as outlined in the Trust Policy: Advance Care Planning to Include Advance Decisions to Refuse Treatment, Statements of Wishes & Feelings & Lasting Powers of Attorney. The Act defines ‘lack of capacity’ as an inability to make a particular decision at a particular time due to “an impairment of or disturbance in the functioning of the mind or brain”. The Act introduces the following key elements when defining capacity: • Time specific – the issue is whether a person can make a decision at a particular time. • Decision specific- capacity relates to a specific decision not a general ability to make decisions. • Diagnostic threshold – must have permanent or temporary impairment of or disturbance in the functioning of the mind or brain. • Not based on appearance and behaviour – i.e. not assuming someone lacks capacity just because they have a learning disability. • Balance of probabilities – lack of capacity must be decided on the balance of probabilities of what is more likely than not. ISSUE 6 – AUGUST 2012 9
Consent to Examination or Treatment – 1.03 12.2 The Act states that a person cannot make a decision if they cannot do one any of the following four things: • Understand information given to them relevant to the decision. • Retain that information long enough to be able to make the decision. • Use or weigh up the information available to make the decision as part of the decision – making process. • Communicate their decision in any way. 12.3 Lack of capacity can be due to (amongst other things): • A stroke or brain injury. • A mental health problem. • Dementia. • A learning disability. • Confusion, drowsiness or unconsciousness because of an illness or the treatment of it. • A neurological disorder. • Substance misuse. 12.4 A disturbance in the functioning of the mind or brain can be permanent or temporary. No-one can be deemed ‘incapable’ by reference simply to a particular diagnosis or mental condition nor by reference to a person’s age or appearance or aspect of their behaviour that might lead to an unjustified assumption about their lack of capacity. 12.5 Those assessing capacity must also consider whether a person who lacks capacity may regain capacity to make the relevant decision at a later date. If the patient may regain capacity the decision maker must decide whether the decision in question can wait until such time as the service user may regain capacity or if the service user’s best interests require that a decision is taken before they regain capacity (for example because there is a medical emergency). 12.6 Any restraint used in connection with the care or treatment of a service user who lacks capacity must be a proportionate response to the likelihood of the service user suffering harm and the seriousness of that harm. 13.0 SEEKING CONSENT FOR ANAESTHESIA 13.1 Where an anaesthetist is involved in a patient’s care, it is their responsibility (not that of a surgeon) to seek consent for anaesthesia, having discussed the benefits and risks. However, in elective treatment it is not acceptable for the patient to receive no information about anaesthesia until their pre-operative visit from the anaesthetist: at such a late stage the patient will not be in a position genuinely to make a decision about whether or not to undergo anaesthesia. Patients should therefore either receive a general leaflet about anaesthesia in out-patients, or have the opportunity to discuss anaesthesia in a preassessment clinic. 13.2 The anaesthetist must ensure that the discussion with the patient and their consent is documented in the anaesthetic record, in the patient’s notes or on the consent form. Where the clinician providing the care is personally responsible for anaesthesia (e.g. where local anaesthesia or sedation is being used), then he or she will also be responsible for ensuring that the patient has given consent to that form of anaesthesia. 13.3 In addition, where general anaesthesia or sedation is being provided as part of dental treatment, the General Dental Council currently holds dentists responsible for ensuring that the patient has all the necessary information. ISSUE 6 – AUGUST 2012 10
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