Consent to Examination or Treatment Policy - Nottinghamshire ...

Consent to Examination or Treatment – 1.03
Part 4A patients who have capacity to consent to a treatment may not be given that
treatment unless they consent. There are no exceptions even in an emergency. The effect
is that treatment can be given without their consent only if they are recalled to hospital.
Part 4A patients who lack capacity to consent to a treatment may be given it if their
Attorney or Deputy or the Court of Protection consents to such treatment. They may also be
given it without anyone’s consent by or under the direction of the Approved Clinician in
charge of the treatment unless:
• The treatment would be contrary to a valid and applicable Advance decision (if the
patient is over 18).
• The treatment would be against the decision of someone with authority under the MCA
2005 to refuse it on the patient’s behalf (if the patient is over 16).
• Force needs to be used to administer the treatment and the patient objects to the
treatment. Force means the actual use of physical force on the patient. The question to
be asked is simply whether the patient objects. All relevant evidence should be taken
into account, so far as reasonably can be. If there is reason to think that a patient would
object if able to do so then the patient should be taken to be objecting.
• Medical treatment for mental disorder may not be given (by anyone in any
circumstances) to SCT patients who have not been recalled to hospital unless the
requirements of Part 4A are met
• Part 4A requires a certificate from a SOAD for:
o Treatment which would require a certificate under section 58 if the patient were
detained.
• ECT and any other types of treatment to which section 58A applies.
• A certificate is not required for a section 58 type treatment during the first month
following a patient’s discharge from detention onto SCT (even if the 3 month period in
section 58 has already expired or expires during that first month).
• When giving Part 4A certificates SOADs do not have to certify whether a patient has or
lacks capacity to consent not whether a patient with capacity is consenting or refusing.
However they may make it a condition of their approval that particular treatments are
given only in certain circumstances. For example, they might specify that a particular
treatment is to be given only with the patient’s consent.
• In an emergency, treatment can be given to Part 4A patients who lack capacity (and who
have not been recalled) by anyone whether or not they are acting under the direction of
an Approved Clinician. It is an emergency only if treatment is immediately necessary to:
• Save the patient’s life;
• Prevent a serious deterioration of the patient’s condition and the treatment does not
have unfavorable physical or psychological consequence which cannot be reversed;
• Alleviate serious suffering by the patient and the treatment does not have
unfavorable physical or psychological consequences which cannot be reversed and
does not entail significant physical hazard;
• Prevent the patient behaving violently or being a danger to themselves or others and
the treatment represents the minimum interference necessary for that purpose, does
not have unfavorable physical or psychological consequences which cannot be
reversed and does not entail significant physical hazard.
ISSUE 6 – AUGUST 2012 23