Legislation in the EDPeer Support 27_01_2015

Sophie Rozwadowski & Kate Myler

What THREE things are needed for valid consent?

1 Capacity

3 Voluntary2 Information

What Four things are required to demonstrate capacity?

1. Understand Info2. Retain Info3. Weigh-up4. Communicate decision

What Information needs to be given?

Broad nature/purpose (Defence against Battery)

Risks, benefits, alternatives (Defence against Negligence)

Refusal in the EDMrs M is brought into the ED after a fall at her nursing home. She presents confused and in a lot of pain. The staff report she might have hit her head during the fall, but Mrs M is refusing a scan.

Q. What do you do?

What do you do?1. Assess Capacity2. Facilitate Capacity (pain relief, support,

information, communication aids, remove sedation, timing)

3. Valid Advanced Refusal/ Competent Refusal Accepted

4. Proxy Consent (If patient lacks capacity)• Lasting Power of attorney• Court appointed deputy

Refusal in the EDYou’ve given Mrs M pain relief, and explained exactly what will happen in the scanner. She is still refusing the scan.

What do you need to consider?

Refusal in the ED• Does she have capacity?

(Confusion, head injury, any history of dementia?)

• Just because you don’t agree doesn’t mean she lacks capacity!!

• Must prove she does not have capacity

• Weigh-up Risk – Doing investigation vs not

• Will she need restraint? Weigh-up benefits vs harm

When is restraint appropriate?

IN BEST INTEREST

TO PREVENT HARM

&

Restraint must be proportionate & the minimum necessary to achieve the treatment goal

-MCA 2005

Treating adults without consent in the ED

Q: When would you use the doctrine of necessity?

A: No time to assess capacity – LIFE THREATENING SITUTION

(Common Law)

Treating adults without consent in the ED

Q: When would you use the principle of best interests?

A: Patient lacks capacity – BALANCE RISKS & BENEFITS

(MCA)

Best Interest (MCA 2005)Q: Which of these can be used to

determine a person’s best interest?A) Person’s ageB) Past/present wishes, feelings, beliefs & valuesC) Person’s appearanceD) Views of those caring for them/LPA as to patient’s

best interest E) Patient’s behaviour which might lead others to

make unjustified assumptions about best interest

Children in the EDTommy comes into the ED with a suspected broken arm – you need to X-ray it – Which frameworks can guide your decision to treat?

Doctrine of necessity

Competent child’s consent

Parental consent (best interests)

Quick check….A multiple trauma patient in the ED requires an urgent fasciotomy. He is unconscious and unable to consent for the operation…Who can consent on behalf of an adult who lacks capacity to consent for a procedure?

1 Someone with LPA2 Someone appointed by the court

Which 2 legal principles apply in treating an adult patient who lack capacity to consent?

1 Doctrine of Necessity2 Principle of Best Interests

Questions?