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VALUES: A SCENARIO

VALUES: A SCENARIO. Adam Pearce & Emily Matthews. As the orthopaedic registrar on-call, you are bleeped to see a patient in A&E. Values: A Scenario. Mrs Bump, a 75 year-old lady has fallen over on some ice and sustained a #NOF. Values: A Scenario.

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VALUES: A SCENARIO

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  1. VALUES: A SCENARIO Adam Pearce & Emily Matthews

  2. As the orthopaedic registrar on-call, you are bleeped to see a patient in A&E Values: A Scenario

  3. Mrs Bump, a 75 year-old lady has fallen over on some ice and sustained a #NOF Values: A Scenario

  4. Before meeting the patient, you read her notes and discover she was diagnosed with Alzheimer’s Disease 4 years ago. You recommend surgery and need to obtain consent. Values: A Scenario

  5. As the orthopaedic registrar on-call, you are bleeped to see a patient in A&E. Mrs Bump, a 75 year-old lady has fallen over on some ice and sustained a #NOF. Before meeting the patient, you read her notes and discover she was diagnosed with Alzheimer’s Disease 4 years ago. You recommend surgery and need to obtain consent. 3 minutes to discuss how you will approach gaining consent for surgery Values: A Scenario

  6. What THREE things are required for valid consent? • Valid consent • Capacity • Information • Voluntariness (free from coercion) Values: A Scenario

  7. What FOUR things are required to demonstrate capacity? N.B. Assume Mrs Bump has capacity unless proven otherwise • Capacity • Understand info • Retain info • Weigh-up • Communicate decision

  8. What information is required? • Valid consent • Capacity • Information • Voluntariness (free from coercion) Values: A Scenario

  9. Information • Broad info • Risks, benefits, alternatives Defence against BATTERY Defence against NEGLIGENCE

  10. You decide Mrs Bump does NOT have capacity to consent to the surgery. What next? Values: A Scenario

  11. Understand • Retain • Weigh-up information • Communicate decision Assess capacity 1. A framework

  12. Understand • Retain • Weigh-up information • Communicate decision Assess capacity 1. • Communication aids • Time of day • Remove sedation Facilitate a capacitous decision if possible 2. A framework

  13. Understand • Retain • Weigh-up information • Communicate decision Assess capacity 1. • Communication aids • Time of day • Remove sedation Facilitate a capacitous decision if possible 2. • Over 18 years of age • Relevant circumstances • Patient not done anything inconsistent with directive • For refusal of life-sustaining treatment • Written • Signed • witnessed A framework Does patient have a valid advance refusal? 3.

  14. Understand • Retain • Weigh-up information • Communicate decision Assess capacity 1. • Communication aids • Time of day • Remove sedation Facilitate a capacitous decision if possible 2. • Over 18 years of age • Relevant circumstances • Patient not done anything inconsistent with directive • For refusal of life-sustaining treatment • Written • Signed • witnessed A framework Does patient have a valid advance refusal? 3. 4. Does patient have someone with lasting Power of Attorney? • Can only give or refuse life-sustaining treatment if this was specifically stated

  15. Understand • Retain • Weigh-up information • Communicate decision Assess capacity 1. • Communication aids • Time of day • Remove sedation Facilitate a capacitous decision if possible 2. • Over 18 years of age • Relevant circumstances • Patient not done anything inconsistent with directive • For refusal of life-sustaining treatment • Written • Signed • witnessed A framework Does patient have a valid advance refusal? 3. 4. Does patient have someone with lasting Power of Attorney? • Can only give or refuse life-sustaining treatment if this was specifically stated Treat in patient’s “Best Interests” (another topic in itself!) 5.

  16. If the patient were a 15 year-old child, Is anything different? Values: A Scenario

  17. Adults over 16 are presumed to have capacity, until proven otherwise • Children under 16 are presumed to lack capacity, unless proven otherwise Is the child GILLICK COMPETENT ? FRASER GUIDELINES - contraception Values: A Scenario

  18. You assess the child as NOT being Gillick competent. Who do you look to for consent? Values: A Scenario

  19. Person with parental responsibility, (who must have capacity) • Mother • Married father • Unmarried father to a child born after 1st December 2003 and named on birth certificate • Adoptive parents • Person with Parental Responsibility Order e.g. civil partner, step-parent • Local Authority for a child in care If the parents are divorced, can the father still give consent? Yes, once parental responsibility is acquired, it remains even after divorce Values: A Scenario

  20. What if the parents disagree with each other on the course of treatment? • Legally only consent of one parent is needed • BUT, Good practice to: • Work with both parents and if possible informally resolve the dispute • Involve child in the decision-making process • Act in child’s best interests Values: A Scenario

  21. GMC interactive case studies - useful for revision http://www.gmc-uk.org/guidance/20473.asp#Case Values: A Scenario

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