Week 2 Med Consent - Adult PDF

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📜Week 2 : Med Consent - AdultWhat is consent? Permission for smt to happen or agreement to do smt Every human being of adult years and sound mind has right to determine what shall be done with his own body - must seek consent (if u dont get consent - it is a battery) What is the right to self-determ...

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Week 2 : Med Consent - Adult What is consent? Permission for smt to happen or agreement to do smt Every human being of adult years and sound mind has right to determine what shall be done with his own body - must seek consent (if u dont get consent - it is a battery) What is the right to self-determination? The right to decide what can and cannot happen to one's body → this is why doctors have a duty to obtain consent **Right to refuse NOT a right to demand tx e.g. Japan has an expensive tx for a disease but that pt cant demand for it to be in the NHS What happens legally if u do not take consent? U have committed a battery. Consent = Defense of battery What is a tort? A civil wrong for which the law provides a remedy(monetary compensation) to the injured party What is a Tort of Battery?

A direct and intentional application of unlawful physical contact Any amt of touching is battery even if there is no proof of harm or injury = no need to prove harm or injury = Actionable per se e.g. Person who pulls patient's hand without their permission to check pulse is liable for battery What are the 3 special circumstances for consent? Blood transfusion - Jehovah's Witness cannot be given blood transfusion under any circumstances : Doctor is liable for battery if he proceeds to give bld transfusion Caesarean section - What if a pregant woman refused a C section? : If she has the capacity to consent and decides to refuse even after explanation her wishes must be respected Amputation of healthy limbs - What if a pt with Body Integrity Identity Disorder or Body Dysmorphic Disorder wants to amputate their healthy limbs - should you as a doctor? : U cannot under the law. What are the exceptions to consent? Emergency cases - u can help someone who is having fits , or drowning, is choking, Heart attack, stroke, or paramedic at a danger scene, or ER doctor who sees patient who comes in w.o consent beforehand *TX provided should only be what is required and not those that can wait till later e.g. Case where breast implant leaked and she underwent emergency procedure to remove and replace implant. During op, dr discovered pt has cancerous growth and proceeded with a masectomy - w.o her consent. In court, it was decided that even though the masectomy will be necessary in the future, the dr should have obtained consent on this occasion What are the forms of consent? Expressed consent : Pt expresses it - doesnt need to be in writing , can be verbal. But many hsps require it in writing as evidence Implied : Patient opens her mouth at the dentist's , Patient extends his arm during BP measurement or injection administration or pulse measurement What are the 3 preconditions of valid consent? ALL 3 must be present in order to get valid consent

Competence, Volantariness, Information Competence - ability to exercise the right to self-determination (ability to say his/her own right) Mental Capacity Act 2005 : pt must have capacity. In one section it has Presumption of capacity : Everytime u see a pt, u are to presume/assume that pt is competent. U dont need to conduct a pt to see if they are competent unless there is smt in their behavior or appearance that suggests otherwise What is the definiton of Incapacity? person lacks capacity in r/t a matter(ability to make medical decisions) if at the material time he is unable to make a decison for himself in r/t to the matter due to a impairment of or a disturbance in the functioning of mind or brain E.g. Mental Illness, Dementia, Alcohol and Drug use, Brain Damage, Sig. Learning disabilities, Concussion When is the person unable to make a decision for himself When he is unable to Understand the info r/t decision Retain that info (dementia/AD disease) Use or weigh that info as part of the process of making that decision To communicate his decision - if pt in locked down syndrome MUST HAVE ALL 4 to say he is capable, if any is missing pt is unable to make own decisions

2 stages to determine incapacity Dr must establish that pt is suffering from impairment or disturbance of functioning of brain or mind Dr must work out if pt can make a decision for himself by fulfilling the 4 steps above *Fear may destroy the capacity to make a decision

Patient agreed for C section. During labour, pt refused C section cuz she was scared of needles(need to give anaesthetic) . Doctors contacted court - court ruled that patient temporarily lacked capacity cuz of her fear of needles - drs were allowed to administer anaesthetic cuz it was in her best interests *Panic can destroy capacity as well Pt had PTSD for C sections - dr granted declaration to do c section Best Interests Test - applied for incompetent patients How do you determine best interests of patient? Patient's beliefs and values View of Carers Patient's past and present wishes Voluntariness - freedom from coercion or undue influence from other ppl : shouldn't be forced or threatened to make decision Pt needed blood transfusion after labour. She agreed to it. Then, she was visited by her mother who was a jehovas witness - then she told dr she doesnt want it. Father said no no my dg must have been influenced by her mother cuz my dg (the pt) is not a jehovas witness. Dr sought a declaration - Court decided that her decision was not voluntary - u can do the bld transfusion Information - how much info a dr should provide to pt for it to be a valid consent? Once pt is informed in broad terms of nature of procedure which is intended and pt consents - consent is real Consent doesnt need to be fully informed to be valid, just has to be real For consent to be valid, the pt doesnt need to know SE or risks - just needs to know the broad nature of the procedure Valid Consent = Real Consent But are doctors under the duty to provide further info? YES! If they dont, it doesnt change validity of consent , wont be a battery but it will be a negligence!...