{"id":1921,"date":"2015-09-17T06:00:43","date_gmt":"2015-09-17T10:00:43","guid":{"rendered":"http:\/\/cancerawarenessnews.com\/?p=1921"},"modified":"2015-10-09T16:12:24","modified_gmt":"2015-10-09T20:12:24","slug":"did-you-consent-before-receiving-medical-treatment","status":"publish","type":"post","link":"http:\/\/cancerawarenessnews.com\/did-you-consent-before-receiving-medical-treatment\/","title":{"rendered":"Did YOU Consent before Receiving Medical Treatment?"},"content":{"rendered":"

VIDEO: \u00a0INFORMED CONSENT TO MEDICAL TREATMENT (FUNNY) . Watch video below<\/h3>\n

Informed consent applies when a person can be said to have given consent based on a clear appreciation and understanding of the facts, and the implications and consequences of an action. \u00a0READ MORE<\/strong><\/p>\n

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English law necessitates that before any medical professional can examine or treat a patient, they must obtain informed consent to do so. Consent can be either explicit (specific consent to carry out a specific action) or implied (not expressly given by a patient, but inferred from their actions, the facts and circumstances of a particular situation, and sometimes a patient’s silence or inaction). Generally there is no legal requirement to obtain written consent but it may be advisable in some circumstances.<\/p>\n

KEEP READING ARTICLE & WATCH INFORMATIVE FUNNY VIDEO \u00a0ON INFORMED CONSENT ON NEXT PAGE<\/strong><\/p>\n

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VIDEO: \u00a0INFORMED CONSENT TO MEDICAL TREATMENT (FUNNY) .<\/h3>\n

A consent form documents that some discussion about the procedure or investigation has taken place but is only evidence of a process, not the process itself. Any discussion should be recorded in the patient’s medical notes.<\/p>\n

The Mental Capacity Act (2005) formalises the area assessing whether the patient is mentally capable of making the decision, and the Mental Health Acts (1983 and amended in 2007) describe the very limited circumstances when a patient can be forced to be hospitalised for assessment and\/or treatment against their wishes.[2][3]<\/p>\n

There is a separate article on Consent to Treatment in Children (Mental Capacity and Mental Health Legislation).<\/p>\n

General principles of consent[4]<\/strong>
\nConsent must be obtained before any examination, treatment or care for competent adult patients.
\nConsent must be given voluntarily and not under any form of duress or undue influence from health professionals, family or friends.
\nCompetent adult patients are entitled to refuse treatment, even where it would clearly benefit their health. The only exception to this rule is where the treatment is for a mental disorder and the patient is detained under the Mental Health Act. A competent pregnant woman may refuse any treatment, even if this would be detrimental to the fetus.
\nConsent can be written, oral or non-verbal. A signature on a consent form does not itself prove the consent is valid – the point of the form is to record the patient’s decision, and the discussions that have taken place.
\nPatients need sufficient information before they can decide whether to give their consent, eg information about the benefits and risks of the proposed treatment, and alternative treatments. If the patient is not offered as much information as they reasonably need to make their decision, and in a form they can understand, their consent may not be valid.
\nConsent is a continuing process rather than a one-off decision. It is important that the patient be given continuing opportunities to ask further questions and to review the decision.
\nPatients can change their minds and withdraw consent at any time, as long as they have the capacity to do so.
\nAll people aged 16 and over are presumed, in law, to have the capacity to consent to treatment unless there is evidence to the contrary. A patient who is suffering from a mental disorder or impairment does not necessarily lack the competence to consent to treatment.<\/p>\n

To demonstrate capacity individuals should be able to:<\/strong>
\nUnderstand what the medical treatment is, its purpose and nature and why it is being proposed.
\nUnderstand the benefits, risks and alternatives.
\nUnderstand the consequences of not receiving the proposed treatment.
\nRetain the information and be able to weigh up the pros and cons in order to arrive at a decision.
\nCommunicate the decision.
\nUnexpected decisions do not prove the patient is incompetent, but may indicate a need for further information or explanation.
\nPatients may be competent to make some health care decisions, even if they are not competent to make others.
\nIt is always best for the person actually treating the patient to seek the patient’s consent. However, you may seek consent on behalf of colleagues if you are capable of performing the procedure in question, or if you have been specially trained to seek consent for that procedure.<\/p>\n

Emergency treatment<\/strong>
\nConsent needs to be sought for emergency treatment for competent patients.
\nIf consent cannot be obtained, doctors should provide medical treatment that is in the patient’s best interests and is immediately necessary to save life or avoid significant deterioration in the patient’s health.
\nHowever, there may be clear evidence of a valid advance refusal of a particular treatment, indicating that treatment should not be given.
\nIf a patient has appointed a welfare attorney, or there is a court-appointed deputy or guardian, this person, where practicable, must be consulted about treatment decisions.
\nBest interests
\nA number of factors should be considered, including:<\/strong><\/p>\n

The patient’s own wishes and values (where these can be ascertained), including any advance decision.
\nClinical judgement about the effectiveness of the proposed treatment, particularly in relation to other options.
\nWhere there is more than one option, which option is least restrictive of the patient’s future choices.
\nThe likelihood and extent of any degree of improvement in the patient’s condition if treatment is provided.
\nThe views of the parents, if the patient is a child.
\nThe views of people close to the patient, especially close relatives, partners, carers, welfare attorneys, court-appointed deputies or guardians, about what the patient is likely to see as beneficial.
\nAny knowledge of the patient’s religious, cultural and other non-medical views that might have an impact on the patient’s wishes.
\nAdults who are not competent to give consent
\nA patient’s capacity to make decisions should be assumed to be present (don’t make assumptions that the patient is unable based on diagnosis, appearance or behaviour, etc.).
\nThe patient’s ability to make decisions should be optimised before concluding they are incapable. Ensure they have adequate time, repeat information as necessary, and use any appropriate communication aids available, eg interpreters, sign language, etc.
\nPatients are allowed to make unwise decisions; the clinicians have to demonstrate the patient is incapable of processing the information and making the decision before acting against their wishes.
\nDecisions subsequently made on behalf of patients ‘without capacity’ always need to be in the patient’s best interest, and also need to be the least restrictive on their basic rights and freedoms.[5]
\nNo one can give consent on behalf of an incompetent adult. However, you may still treat such a patient if the treatment would be in their best interests.
\n‘Best interests’ go wider than best medical interests and include factors such as the wishes and beliefs of the patient when competent, their current wishes, their general well-being and their spiritual and religious welfare.
\nPeople close to the patient may be able to give you information on some of these factors.
\nWhere the patient has never been competent, relatives, carers and friends may be best placed to advise on the patient’s needs and preferences.
\nIf an incompetent patient has clearly indicated in the past while competent that they would refuse treatment in certain circumstances (an ‘advance refusal’), and those circumstances arise, you must abide by that refusal.<\/p>\n

Advance decisions[6]<\/strong>
\nPeople who understand the implications of their choices can state in advance how they wish to be treated if they suffer loss of capacity. An advance decision can be a written document, a witnessed oral statement, a signed printed card, a smart card or a note of a particular discussion recorded in the patient’s file.<\/p>\n

In England and Wales, advance decisions are covered by the Mental Capacity Act. The decision should comply with the provisions of the Mental Capacity Act if it is to be legally binding.
\nAny person can make an advance decision, including an individual under the age of 18. In the case of young people under the age of 18, advance decisions should be taken into account and accommodated, if possible, but do not necessarily have the same status as those of adults.
\nAn advance decision can be of two main types:
\nA statement authorising or requesting specific procedures.
\nA clear instruction refusing some or all medical procedures (also called an advance directive).
\nAn advance refusal is legally binding providing that the patient is an adult, the patient was competent and properly informed when reaching the decision, it is clearly applicable to the present circumstances and there is no reason to believe that the patient has changed his or her mind. If an advance decision does not meet these criteria but appears to set out a clear indication of the patient’s wishes, it will not be legally binding but should be taken into consideration in determining the patient’s best interests.
\nAdvance requests or authorisations do not have the same binding status but should be taken into account in assessing best interests.
\nWhere the patient’s advance decision relates to a refusal of life-prolonging treatment this must be recorded in writing and witnessed. The patient must acknowledge in the written decision that they intend to refuse treatment even though this puts their life at risk.
\nAdvance decisions can be overruled if the individual is being treated compulsorily under mental health legislation. However, a valid and applicable advance refusal of treatment for conditions that are not covered by the compulsory powers of the legislation will be binding.
\nIn England and Wales, an advance decision is superseded if the patient subsequently gives someone lasting power of attorney to make that decision.
\nMental Health Act relevant to consent
\nThe Consent to Treatment Provisions are dealt with in Part 4 of the Mental Health Act, which applies to:<\/p>\n

Treatments for mental disorder.<\/strong>
\nAll formal patients except those who are detained under sections 4, 5, 35, 135 and 136. The Act does not apply to those people subject to Guardianship or Supervised Discharge, who have the right to refuse treatment, except in emergencies.
\nWhere a person has been deemed to have given their consent to treatment under Section 57 or Section 58, the person can withdraw that consent at any time. The treatment must then stop and the appropriate procedures be followed, unless discontinuing treatment would cause ‘serious suffering’ to the patient, in which case the treatment can be continued.<\/p>\n

Section 57: Treatment requiring consent and a second opinion<\/strong>
\nSome treatments are deemed so potentially hazardous that someone cannot automatically be given them even if they do consent.
\nThree people (one doctor and two others who cannot be doctors) have to certify that the person concerned is capable of understanding the nature, purpose and likely effects of the treatment and has consented to it.
\nThese three people are appointed by the Mental Health Act Commission. The treatments which fall into this category are:
\nAny surgical operation for destroying brain tissue or for destroying the functioning of brain tissue.
\nThe surgical implantation of hormones for the purposes of reducing the male sex drive.
\nSection 58: Treatment which requires consent or a second opinion
\nApplies to people who are detained under certain Sections without their consent, or in cases where the person is not able to give their informed consent to that treatment.
\nThe treatments which fall under Section 58 requirements are:
\nMedication for the person’s mental disorder: if three months have gone by since the person first had the treatment during their current period of detention under the Act. In the first three months the treatment can be given without consent, and without the Section 58 requirements being necessary. The three-month period starts when medication for the mental disorder is first given.
\nElectroconvulsive therapy (ECT).<\/strong>
\nIf the person is capable of understanding the nature, purpose and likely effects of the treatment and consents to it, the Responsible Medical Officer (RMO) has to certify in writing that understanding and consent are present.
\nIf the person concerned is capable of understanding the nature, purpose and likely effects of the treatment and does not consent to it, or is not capable of understanding the nature, purpose and likely effects of the treatment and therefore cannot consent to it, then a doctor is appointed by the Mental Health Act Commission to give a second opinion.
\nThe appointed doctor must consult two people who have been professionally involved in the patient’s medical treatment, one of whom must be a nurse, whilst the other can be neither a doctor nor a nurse.
\nThe certificates must state the plan of treatment in precise terms, eg a range of doses of medication or number of treatments of ECT. If the plan of treatment is to be changed, new certificates are required.
\nThe provisions of Section 58 do not prevent treatment being given in an emergency, as set out in Section 62.
\nSection 62: Urgent treatment
\nThe requirements of Section 57 and Section 58 do not have to be followed when urgent treatment is required:<\/p>\n

To save the patient’s life.<\/strong>
\nTo prevent a serious deterioration in the patient’s condition, so long as the treatment is not irreversible.
\nTo alleviate serious suffering so long as the treatment is neither irreversible nor hazardous.
\nTo prevent the patient from behaving violently or being a danger to self or others so long as the treatment is neither irreversible nor hazardous, and represents the minimum interference necessary.
\nSection 37: Hospital Orders made by the Courts
\nThis Section allows a Court to send a person to hospital for treatment, or to make the person subject to Guardianship, when the outcome might otherwise have been a prison sentence. The Order is instead of imprisonment, a fine or probation.
\nThe person concerned:
\nWill have been convicted by a Magistrates Court or Crown Court of an offence which could be punished with imprisonment (except in the case of murder, where the Court has to impose a sentence of life imprisonment in all cases).
\nMay not have been convicted, but may be before a Magistrates Court charged with an offence which could lead to imprisonment if the person were convicted. Without convicting the accused person, the Court can make a Hospital Order under Section 37 if the person has mental illness or severe mental impairment.
\nThe initial period is six months, beginning on the date of the Order. The Order can be renewed under Section 20 for six months and then annually.<\/p>\n

The Court has to be satisfied:
\nthat the person has at least one of the four types of mental disorder, on the basis of evidence supplied by two doctors (with both doctors agreeing on at least one of the types), and
\nthat the nature and degree of the mental disorder makes it appropriate for the person to be detained in hospital for medical treatment (that the treatment is likely to alleviate or prevent a deterioration of the person’s condition in the case of psychopathic disorder or mental impairment), and
\nthat making a Section 37 Order is the most suitable way of dealing with the person and that a specific hospital is willing and able to admit the person within 28 days.
\nSection 61: Review of treatment
\nWhere a plan of treatment is being carried out under Section 57, or under Section 58 without consent, the Responsible Medical Officer has to provide a report to the Mental Health Act Commission if the period of detention is renewed under Section 20.
\nThe Commission may demand a report at any other time if it wishes.
\nThe Commission can cancel the certificate under which treatment is being given.
\nIn the case of people subject to Restriction Orders a report on the treatment being given has to be provided for the Commission:
\nsix months after the restriction order or direction is made, and
\nat times when the RMO reports to the Home Office on the person’s current condition.<\/p>\n