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A person can be found to lack the capacity to make a decision without taking any steps to help them.
False
Making an unwise decision is enough to indicate a lack of capacity.
False
Interventions must prioritize minimizing restrictions on a person's rights and freedoms.
True
Every adult patient is presumed to lack the capacity to make decisions about their own health care.
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Patients have the right to have an advocate present during discussions about their treatment.
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A lack of capacity can only arise from long-term disabilities.
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Decision-making capacity should be defined in a general, broad manner.
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An individual's ability to reason and express a choice is irrelevant to their decision-making capacity.
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Informed consent is a one-time event.
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Patients have the right to determine what shall be done with their bodies.
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Informed consent requires that patients understand and retain information provided to them.
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Consent to medical treatment is always considered to be voluntary.
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Informed consent justifies actions that would normally be considered trespass.
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The success of informed consent is dependent on the doctor’s ability to explain procedures.
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The ethical principles underpinning patient care include recognition of cultural influences on health.
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Patients' challenges in dealing with chronic disease are irrelevant in the consent process.
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DSS is able to apply to court in cases of non-compliance.
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A court declaration on a person's capacity is permanent and cannot be reviewed.
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A Decision-Making Representative can make decisions regarding life-sustaining treatment.
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The court must consider a person's known will and preferences when appointing a DM Representative.
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A decision-making assistant can make final decisions on behalf of an individual.
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A DM Representative can restrict contact with others.
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A co-decision-maker acts alongside a decision-maker to make decisions.
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The scope of authority for a Decision-Making Representative can include administering medication to modify behavior.
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In emergency situations, consent must always be obtained before providing medical treatment.
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The doctrine of necessity applies when it is impossible to obtain consent for an immediate procedure.
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It is optional for the hospital to seek assistance from the court after providing emergency treatment.
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A doctor is responsible for ensuring that a patient has given consent before treatment.
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Doctors can delegate the entire consent process to another person without any responsibility.
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In emergencies, treatment should only be provided if it is in the best interests of the assisted person.
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Delegation of consent taking can be done to anyone regardless of their training.
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A doctor has no obligation to inform the patient about the risks involved in a treatment.
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Patients aged 15 years are entitled to give consent to surgical treatment.
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Parents or guardians usually give consent for medical treatment for patients under the age of 16.
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Young people aged 16 and 17 can refuse treatment against medical advice.
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Patients over 18 years may consent to organ or tissue donation.
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It is not recommended to involve parents or guardians when a child under 16 wants to make a healthcare decision independently.
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A decision-making assistant has the authority to make final decisions on behalf of the appointer.
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In co-decision-making, relevant decisions must be made jointly by the appointer and the co-decision-maker.
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A co-decision-maker is typically someone who does not have a pre-existing relationship of trust with the appointer.
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Both decision-making assistants and co-decision-makers require a formal capacity assessment before appointment.
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A decision-making assistant is formally registered with the Decision Support Service.
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The doctor's role in communication includes ensuring the patient understands her condition and treatment options.
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A patient's decision is considered genuine if it is expressed solely to appease others or due to external pressure.
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The principle of best interests is no longer relevant in the context of the Assisted Decision-Making (Capacity) Act 2015.
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Human rights framework mandates that even minor interferences with physical integrity require respect for an individual's will.
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A decision-making assistant can independently make final decisions for an individual without any input from that individual.
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Patients aged 16 years have the right to give consent for their medical treatment.
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The term 'capacity' refers to a rigid classification with no potential for variation between categories.
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Patients' experiences with chronic diseases are considered irrelevant in the informed consent process.
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Advance Healthcare Directives allow a person to make a legally binding agreement regarding their healthcare wishes.
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A Designated Healthcare Representative can make decisions without considering the wishes expressed in an Advance Healthcare Directive.
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An Instructional directive is one of the two forms of Advance Healthcare Decision-Making.
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The Powers of Attorney Act 1996 only applies to financial decisions and does not cover healthcare.
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The court may appoint a Decision-Making Representative if the relevant person's capacity is deemed insufficient.
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Advance Healthcare Directives can be used to appoint someone to make decisions about life-sustaining treatment.
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A Decision-Making Representative has the authority to prohibit contact with others.
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Advance Healthcare Decisions must be made when the individual has lost the capacity to make their own healthcare decisions.
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Proxy directives are a specific type of Advance Healthcare Directive referring to instructions for treatment.
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The court's declaration regarding a person's capacity must be periodically reviewed.
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A Decision-Making Representative may make decisions regarding life-sustaining treatment.
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The ethical rationale for Advance Healthcare Directives includes a respect for autonomy.
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The authority of a Decision-Making Representative is unrestricted and includes all aspects of a person's affairs.
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In appointing a Decision-Making Representative, the court considers the complexity of the relevant person's financial affairs.
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A decision-making assistant can make final decisions on behalf of an individual.
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The court may make decisions for a person only if the matter is considered urgent.
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Sharing identifiable patient information requires the patient's consent and consideration of the minimum necessary information for disclosure.
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Anonymised information does not identify a patient and is always preferred over identifiable information for disclosures.
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You are allowed to disclose patient information to their relatives without consent if you believe it will help them.
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Informed consent is only required for sharing information in research when using anonymised data.
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A patient’s relatives can be informed about the patient’s condition if sought for research purposes.
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The duty of confidentiality applies to all personnel who receive identifiable patient information.
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Patients have the right to decide if their information can be shared, regardless of the potential risk involved.
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For research purposes, coded data can be shared without explicit patient consent.
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An intern can be delegated any part of the consent process, regardless of their familiarity with the procedure.
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Every adult patient has the right to refuse medical treatment and withdraw consent.
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Minors aged 15 years can consent to surgical treatment without parental approval.
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The consent process is a one-off event that does not require ongoing communication with the patient.
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A patient under stress or in pain is considered capable of making a calm and reasoned decision about their treatment.
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It is necessary to obtain consent from a parent or guardian if a minor has given effective consent for treatment.
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Patients must always be informed of the possible consequences of refusing treatment.
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The patient's medical notes should document the discussion about refusal of treatment and the information provided.
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Informed consent requires patients to understand and retain the information provided to them.
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True consent can only be given if patients are fully aware of the risks associated with their treatment.
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A person of sound mind may always be presumed to have the capacity to make healthcare decisions.
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Informed consent is a one-time event that does not require ongoing discussion.
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A doctor can completely delegate the consent process to another individual without facing any responsibility.
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The success of informed consent is primarily dependent on the doctor's ability to explain the procedures involved.
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Patients living with chronic diseases do not face challenges relevant to the consent process.
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Every adult patient has the right to determine what should be done with their own body.
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A Decision-Making Representative can make decisions regarding the provision of life-sustaining treatment.
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In appointing a Decision-Making Representative, the court must disregard the known preferences of the relevant person.
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The court may make a declaration that a relevant person lacks capacity based solely on their past decisions.
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A decision-making assistant holds the same authority as a decision-making representative in making decisions on behalf of others.
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Periodic reviews of capacity statements are optional for the Decision Support Service.
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The appointment of a Decision-Making Representative must consider the complexity of financial affairs and the expertise available.
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A Decision-Making Representative may restrain the relevant person under normal circumstances.
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The court's declarations about a person's capacity are subject to periodic review.
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Young people aged 18 and older have the right to refuse medical treatment based on their own judgment without parental consent.
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A young person's stable views significantly impact their ability to provide informed consent for medical treatment.
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Parents have an absolute legal right to access their child's medical records even after the child turns 18.
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The principles guiding treatment decisions for young people include their physical and mental health considerations.
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Genetic testing can only be performed on adult patients who have the capacity to consent.
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Confidentiality guarantees must be provided to young individuals seeking medical treatment.
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The risks and benefits of a medical intervention should always be clearly communicated to young patients.
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Existence of public health considerations is irrelevant when making decisions for minors in medical settings.
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Advance Healthcare Directives (AHDs) allow a person to refuse treatment and appoint someone to make healthcare decisions on their behalf.
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A person can use an Advance Healthcare Directive to give unlimited authority to their Designated Healthcare Representative, overriding all medical guidance.
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An instructional directive in Advance Healthcare Decision-Making specifies the treatment a person consents to or refuses in the event they lose capacity.
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The Enduring Powers of Attorney regulations do not cover healthcare decisions.
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Advance Healthcare Decision-Making only allows for direct treatment instructions and does not include the appointment of a proxy.
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A legally recognized Advance Healthcare Directive requires formal registration with a healthcare authority.
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The 2015 Act establishes a framework that protects the autonomy of individuals in making healthcare decisions.
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An Advance Healthcare Directive cannot be altered once it is signed.
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Study Notes
Capacity
- A person lacks capacity if they don't have the ability to comprehend, reason, and express a choice about a specific decision.
- All practicable steps should be taken to assist someone in making a decision before they are considered to lack capacity.
- An unwise decision does not automatically indicate a lack of capacity.
- Any interventions made must be necessary and minimally restrictive for the person’s rights and freedom.
- The right to dignity, bodily integrity, privacy, and autonomy must be respected during any intervention.
- Intervention must consider the person’s past and present will and preferences, as reasonably ascertainable.
- Adults are presumed to have the capacity to make decisions about their own healthcare.
- A lack of capacity may arise from a long-term or permanent condition or disability, or from short-term illness or infirmity
- Adults who are considered not to have capacity are entitled to respect for their dignity and personal integrity.
- The doctor’s duty is to help patients make decisions by giving them information in a clear and easy-to-understand way.
- Patients have the right to an advocate of their choice when discussing their condition and treatment.
Informed Consent
- Every adult of sound mind has the right to determine what happens to their body.
- Informed consent justifies medical procedures that would otherwise be considered trespass to the person's body.
- True consent means the patient can knowledgeably evaluate options and risks, and make a choice.
- Informed consent is a process, not a one-off event.
- Patients must be able to understand and retain information to make informed decisions.
- When giving consent, patients are making a voluntary choice.
- Doctors should help patients make informed choices that are right for them.
Decision-Making Representation
- The court may make a declaration that a person lacks capacity for a particular decision.
- The court may appoint a Decision-Making Representative to make decisions on behalf of the person.
- The Decision-Making Representative must consider the person’s known will and preferences.
- The Decision-Making Representative is restricted by a court order and may not make decisions about life-sustaining treatment.
Emergency Situations
- In an emergency, treatment can be provided without consent if it is necessary to save a life or prevent significant deterioration of a patient’s health.
- This is known as the doctrine of necessity.
- Hospitals must seek the assistance of the court within a reasonable time after treatment is provided.
Children & Young People
- The primary duty of a doctor when treating children and young people is to act in their best interests.
- Parents or guardians will usually be asked to give consent for medical treatment on behalf of children under 16 years of age.
- Young people should be involved in healthcare discussions as much as possible and given information suitable for their age.
Responsibility for Seeking Consent
- The doctor providing treatment is responsible for ensuring the patient has given consent and that the patient understands the procedure, risks and alternatives.
- This responsibility can be delegated to a suitably trained and qualified person.
- The doctor remains responsible for ensuring that informed consent has been obtained.
Role of Communication
- The doctor's role involves dialogue to ensure the patient understands the seriousness of their condition, treatment benefits and risks and any alternatives.
- The doctor must provide comprehensible and informative communication for the patient to make informed decisions.
Impact of Capacity: The Traditional View
- Traditional view saw capacity as a definitive divider.
- There was no room for movement between categories.
Challenges to the Traditional View
- Empirical evidence suggests a range of capacities.
- Scandals and abuses challenged traditional views.
- Human Rights issues, particularly the right to privacy and physical integrity.
Human Rights
- European Convention on Human Rights
- Even minor interference with physical integrity is a violation of Article 8 (right to private life).
- United Nations Convention on the Rights of Persons with Disabilities (CRPD)
- Article 12(3) affirms that persons with disabilities have equal legal capacity in all aspects of life.
Assisted Decision-Making (Capacity) Act 2015
- Complex legislation with 129 sections and 3 Schedules.
- Linked to the ratification of the CRPD.
- Replaced "Best interests" with a range of supported decision-making measures.
Guiding Principles
-
Decision-Making Assistant
- Appointed by a person who feels their capacity is or might be in question.
- Functions include assisting with information, explaining information, communicating will and preferences, assisting with decision making and implementation.
-
Co-Decision-Making
- Appointed by a person (appointer) who feels their capacity is or might be in question.
- Function include: advising the appointer, helping with information, communicating will and preferences, joint decision making, and ensuring implementation.
- The agreement is registered with the Decision Support Service (DSS) which periodically reviews it.
-
Decision-Making Representation
- Court declares a person lacks capacity.
- Court may make decisions if urgent.
- Declaration is subject to court review.
- Court can appoint a Decision-Making Representative (DMR)
Decision-Making Representative: Scope of Authority
- Cannot prohibit contact with others.
- Authority is confined to decisions listed in the court order.
- Cannot make decisions on life-sustaining treatment.
- Cannot restrain the person unless in exceptional emergency circumstances.
- Cannot administer medication to control or modify behavior.
Enduring Powers of Attorney
- Extended powers of Attorney legislation under the Powers of Attorney Act 1996 and the Enduring Powers of Attorney Regulations 1996.
- Extended to cover healthcare.
Advance Healthcare Directives (AHDs)
- It is ethically important because it respects autonomy and acknowledges the right to a life structured by one's values.
- The 2015 Act sets out legal guidelines for AHDs.
- A directive-maker can legally refuse treatment and make treatment requests with their AHD.
- They can also appoint a Designated Healthcare Representative to make decisions based on their AHD.
Forms of Advance Healthcare Decision-Making
- Definition: A written statement from an adult outlining consent or refusal of treatment if they lose capacity.
- Two types:
- Instructional directive: Directions for treatment.
- Proxy directive: Appoints someone to make decisions.
Confidentiality
- Sharing information is important for patient care and safety.
- Doctors must protect their patients’ privacy.
- Before sharing any identifiable information, consider:
- Using anonymized information.
- Sharing the minimum information with the minimum necessary people.
- Ensuring the recipients understand the information is confidential.
Disclosure with consent
- Obtain the patient’s consent before providing identifiable information:
- To relatives and close friends.
- For research.
- Use coded or pseudonymised data where possible.
Ethics assessment in IPCP
- Reflect on a patient encounter that involved an ethical principle.
- Examples of ethical principles:
- Consent
- Confidentiality
- Autonomy
- Beneficence
- Non-maleficence - Justice
Informed Consent
- Informed consent is a process not a once-off event.
- Consent justifies what would otherwise be prohibited, for example, trespass to the person’s body.
- True consent to what happens to one’s self is the informed exercise of a choice.
- The success of informed consent depends on patients being able to understand and sufficiently retain the information they are given so as to enable them to analyse that information and use it to make a decision.
- When patients give consent, they are making a voluntary choice.
- You should help patients make decisions that are informed and right for them.
Decision-Making Representation
- The court makes a declaration that the relevant person lacks capacity.
- The court may appoint a Decision-Making Representative, a person who can make certain decisions for the individual.
- When appointing a DM Representative, the court will take into account the known will and preferences of the relevant person.
- The court will also consider the existing relationships within the family as well as any conflict of interest.
Advance Healthcare Directives (AHDs)
- An Advance Healthcare Directive (AHD) is a legally recognised arrangement that lets a person plan ahead for healthcare and treatment decisions.
- An AHD allows a person to make a legally binding refusal of treatment and to make treatment requests.
- A directive-maker may also appoint someone to act as their Designated Healthcare Representative, and give this person authority to consent to and refuse treatment, including life-sustaining treatment, always with reference to the AHD.
Consent to genetic testing
- Genetic testing can help to diagnose an illness or help to predict the development of an illness in the future.
- Patients must have counselling about the possible consequences of genetic testing before you seek their consent.
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Description
This quiz explores the concept of capacity in decision-making. It covers the criteria for determining a lack of capacity and emphasizes the importance of dignity and personal integrity during interventions. Learn the legal and ethical considerations surrounding individuals' rights to make their own healthcare choices.
