Informed Consent in Healthcare

• Focuses on consent and capacity in healthcare, especially within the context of pharmacy
• Explains the legal and ethical responsibilities of healthcare professionals

Consent

• Defined as expressing willingness, giving permission, or agreeing to something
• Respects patient rights and is crucial for building partnerships between healthcare providers and patients
• Pharmacy professionals have a legal and professional obligation to obtain consent

Legal Requirements

• Must adhere to laws and best practices related to consent in their daily work

Types of Consent

• There are two types of consent
• Explicit (Express) Consent
  • Specific permission given verbally or in writing
• Implied Consent
  • Consent inferred by actions, like bringing a prescription to be dispensed
  • Valid only if the person fully understands what they are agreeing to
  • Pharmacy professionals must use professional judgment to determine which type of consent to obtain

Obtaining Valid Consent

• Requires the person to
• Have the capacity to give consent
• Act voluntarily
• Possess sufficient balanced information to make an informed decision
• Be capable of using and weighing up the information provided
• Comprehend the consequences of not consenting

Material Risks and Montgomery Principle

• A case study (Montgomery v Lanarkshire Health Board) emphasized the importance of informing patients about "material risks"
• The Supreme Court rejected the 'Bolam Principle' and highlighted patient-centered decision-making
• Healthcare professionals must inform patients of material risks involved in recommended treatments and reasonable alternatives
• The Montgomery Principle applies to all consultations where treatment is provided
• "Material risk" is defined as a risk a reasonable person in the patient's position would likely consider significant
  • Context-dependent and varies with the patient's values
  • Uncommon risks can still be material

Best Practices for Consent

• Healthcare professionals should
• Listen to the patient
• Respect the patient's views
• Discuss the diagnosis, prognosis, and treatment plan
• Share all relevant clinical information
• Maximize opportunities for patient decision-making
• The relationship should be built on openness, trust, and clear communication

Ensuring Patient Understanding

• Make sure the patient understands
• The nature of the process
• Their role in it
• Provide relevant information
• Establish a shared understanding of expectations around treatment

Mental Capacity

• According to the Mental Capacity Act 2005 (England & Wales)
• A person lacks capacity if they cannot make or communicate a decision due to an impairment affecting their mind/brain
  • Degrees of capacity do not exist
  • Capacity can vary for different decisions
  • Children under 16 are presumed to lack capacity unless proven otherwise

Assessing Capacity in Adults

• Presume adults (16+) have capacity unless proven otherwise
• A person lacks capacity if they cannot understand, retain, comprehend, or communicate a decision even after receiving information
• Professionals cannot assume a lack of capacity based on a single instance
• Pharmacy professionals must support individuals in making their own decisions
• Discuss at optimal times, use appropriate communication methods, involve support, etc

Seeking Consultation

• If capacity is uncertain, consult other healthcare professionals.
• Consider the permanence of the condition, optimal benefits, patient choices, advanced planning documents, views of family/next of kin, and professional opinions

Assessing Capacity in Children and Young People

• Parents or legal guardians typically provide informed consent for those under 16
• Parents can give consent for any clinical procedure a "reasonable parent" would approve

Fraser Guidelines

• Set out circumstances when a doctor can provide contraceptive advice/treatment to an underage person without parental knowledge/permission
• Applied to all treatments for underage individuals
• Healthcare professionals should ensure the young person cannot be persuaded to inform parents, understands the advice, and is likely to suffer without treatment
• It needs to be in the young person's best interests to receive advice/treatment without parental consent

Parental Responsibility and Emergencies

• Parental rights to consent remain until the child is 18
• Applies to both parents, regardless of marital status
• Local authorities share parental responsibility for children under care orders
• Legal rights end if a minor is adopted
• In emergencies, treatment can be provided without consent if it is in the person's best interest to save their life or prevent deterioration, considering advanced directives.