Adult Medical Emergency Handbook - Scottish Intensive Care Society

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as far as is reasonably possible.
• minimise the restriction of the patient’s freedom - for example if it
was considered unlikely that the patient’s clinical condition would
be compromised by waiting until the patient regained the capacity
to give consent, then the treatment should be delayed until such
time.
• respect the patient’s residual autonomy, thereby empowering them
as much as possible.
Therefore any medical, surgical or nursing intervention,
diagnostic study or physiotherapy is covered under the act.
How does this work in practice?
• Every adult patient who is incapable of making decisions with
regard to their medical treatment or care should have a completed
Certificate of Incapacity filed in the front of their medical notes.
The Certificate will replace consent forms unless the patient has a
legally appointed proxy decision maker.
Any immediate treatment to save life or prevent serious
deterioration in the patient’s medical condition is exempt from
the procedures laid down in the act.
• In all other cases the doctor primarily responsible for the patient
can authorise the provision of medical treatment according to the
general principles of the Act. However if a proxy decision maker
has been nominated consent must be obtained from them prior to
any procedure, other than emergency treatment.
Proxy decision makers include:
• Welfare attorney. The patient, in anticipation of their becoming
incapacitated, nominates this power of attorney. The power of
attorney must be registered with The Public Guardian who should
issue a certificate in the prescribed form.
• Welfare Guardian. This proxy is appointed by a sheriff when
an individual has become incapacitated or has never had the
capacity to make decisions pertaining to their medical treatment.
• Intervention Order. Representation is provided by the courts on
behalf of the incapacitated adult.
20 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11