Capacity for Consent - How Much Do We Know About It?

Kate EvansSpecialist Registrar in Emergency Medicine

Derriford Hospital, Plymouth

Outline

• Background• Study methods• Results• Discussion• Conclusions

Why did I look at this?

• Working in ED• Masters in Medical Law• Mental Capacity Act• Previous study

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.”

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

Study methods

• doctors (42), • nurses (21) and • ambulance staff (23)

in ED in Birmingham

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

Questionnaire

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

• NO

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

Questionnaire

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

• NO

Results• What three points would you look for in

assessing one’s capacity to give valid consent?

Results• If a competent adult refuses medical

treatment that you are proposing can you still treat them under common law?

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?

Results• Should the Mental Health Act be used to treat

physical illness when someone with a mental disorder is refusing treatment?

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

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

Study conclusion

• More training is needed!!

Any Questions