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VALUES:A SCENARIO
Adam Pearce & Emily Matthews
Values: A Scenario
As the orthopaedic registrar on-call, you are bleeped to see a patient in A&E
Values: A Scenario
Mrs Bump, a 75 year-old lady has fallen over on some ice and sustained a #NOF
Before meeting the patient, you read her notes and discover she was diagnosed with Alzheimer’s Disease 4 years ago.
You recommend surgery and need to obtain consent.
Values: A Scenario
Values: A Scenario
As the orthopaedic registrar on-call, you are bleeped to see a patient in A&E.
Mrs Bump, a 75 year-old lady has fallen over on some ice and sustained a #NOF.
Before meeting the patient, you read her notes and discover she was diagnosed with Alzheimer’s Disease 4 years ago.
You recommend surgery and need to obtain consent.
3 minutes to discuss how you will approach gaining consent for surgery
Values: A Scenario
Valid consent
Capacity InformationVoluntariness
(free from coercion)
What THREE things are required for valid consent?
What FOUR things are required to demonstrate capacity?
Understand info Retain info Weigh-up Communicate
decision
Capacity
N.B. Assume Mrs Bump has capacity unless proven otherwise
Values: A Scenario
Valid consent
Capacity InformationVoluntariness
(free from coercion)
What information is required?
Information
Broad infoRisks,
benefits, alternatives
Defence against BATTERY Defence against NEGLIGENCE
Values: A Scenario
You decide Mrs Bump does NOT have capacity to consent to the surgery.
What next?
Assess capacityA
fram
ewor
k1.
• Understand• Retain• Weigh-up information• Communicate decision
Assess capacity
Facilitate a capacitous decision if possible
A fr
amew
ork
1.
2.• Communication aids• Time of day• Remove sedation
• Understand• Retain• Weigh-up information• Communicate decision
Assess capacity
Facilitate a capacitous decision if possible
Does patient have a valid advance refusal?
A fr
amew
ork
1.
2.
3.
• Communication aids• Time of day• Remove sedation
• Understand• Retain• Weigh-up information• Communicate decision
• Over 18 years of age• Relevant circumstances• Patient not done anything inconsistent with
directive• For refusal of life-sustaining treatment
• Written• Signed• witnessed
Assess capacity
Facilitate a capacitous decision if possible
Does patient have a valid advance refusal?
Does patient have someone with lasting Power of Attorney?
A fr
amew
ork
1.
2.
3.
4.
• Communication aids• Time of day• Remove sedation
• Understand• Retain• Weigh-up information• Communicate decision
• Over 18 years of age• Relevant circumstances• Patient not done anything inconsistent with
directive• For refusal of life-sustaining treatment
• Written• Signed• witnessed
• Can only give or refuse life-sustaining treatment if this was specifically stated
Assess capacity
Facilitate a capacitous decision if possible
Does patient have a valid advance refusal?
Treat in patient’s “Best Interests”(another topic in itself!)
Does patient have someone with lasting Power of Attorney?
A fr
amew
ork
1.
2.
3.
4.
5.
• Communication aids• Time of day• Remove sedation
• Understand• Retain• Weigh-up information• Communicate decision
• Over 18 years of age• Relevant circumstances• Patient not done anything inconsistent with
directive• For refusal of life-sustaining treatment
• Written• Signed• witnessed
• Can only give or refuse life-sustaining treatment if this was specifically stated
Values: A Scenario
If the patient were a 15 year-old child,
Is anything different?
Values: A Scenario
• Adults over 16 are presumed to have capacity, until proven otherwise
• Children under 16 are presumed to lack capacity, unless proven otherwise
Is the child GILLICK COMPETENT ?
FRASER GUIDELINES- contraception
Values: A Scenario
You assess the child as NOT being Gillick competent.
Who do you look to for consent?
Values: A Scenario
Person with parental responsibility, (who must have capacity)
• Mother• Married father• Unmarried father to a child born after 1st
December 2003 and named on birth certificate
• Adoptive parents• Person with Parental Responsibility Order
e.g. civil partner, step-parent• Local Authority for a child in care
If the parents are divorced, can the father still give consent?
Yes, once parental responsibility is acquired, it remains even after divorce
Values: A Scenario
What if the parents disagree with each other on the course of treatment?
Legally only consent of one parent is needed BUT, Good practice to:
- Work with both parents and if possible informally resolve the dispute
- Involve child in the decision-making process
- Act in child’s best interests
http://www.gmc-uk.org/guidance/20473.asp#Case
GMC interactive case studies - useful for revision
Values: A Scenario
