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This presentation by Kate Evans, Specialist Registrar in Emergency Medicine at Derriford Hospital, explores the complexities of assessing mental capacity for consent. It outlines study methods involving healthcare professionals in Birmingham, highlighting key findings on the criteria for valid consent and the implications of patient refusals. The study emphasizes the importance of adequate training for emergency staff in line with the Mental Capacity Act and NICE guidelines, advocating for better practices in emotionally charged situations often faced in the Emergency Department.
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Capacity for Consent - How Much Do We Know About It? Kate Evans Specialist Registrar in Emergency Medicine Derriford Hospital, Plymouth
Outline • Background • Study methods • Results • Discussion • Conclusions
Why did I look at this? • Working in ED • Masters in Medical Law • Mental Capacity Act • Previous study
Capacity • What does this mean? • Why this is important to us? • NICE “All healthcare professionals who have contact, in the emergency situation, with people who have self-harmed should be adequately trained to assess mental capacity and to make a decision about when treatment and care can be given.”
Re C In order to make a decision a patient must be able to • Take in and retain information • Believe it • Weigh that information, balancing risks and needs Mental Capacity Act
Study methods • doctors (42), • nurses (21) and • ambulance staff (23) in ED in Birmingham
Questionnaire • What three points would you look for in assessing one’s capacity to give valid consent? • Take in and retain information • Believe it • Weigh that information, balancing risks and needs
Questionnaire • If a competent adult refuses medical treatment that you are proposing can you still treat them under common law? • NO
Questionnaire • If someone is deemed incapable of signing a consent form for a procedure, is it legally necessary to get a relative to sign it instead? • NO
Questionnaire • Should the Mental Health Act be used to treat physical illness when someone with a mental disorder is refusing treatment? • NO
Results • What three points would you look for in assessing one’s capacity to give valid consent?
Results • If a competent adult refuses medical treatment that you are proposing can you still treat them under common law?
Results • If someone is deemed incapable of signing a consent form for a procedure, is it legally necessary to get a relative to sign it instead?
Results • Should the Mental Health Act be used to treat physical illness when someone with a mental disorder is refusing treatment?
Discussion • We are leaving ourselves open to criticism and legal action • It is not always easy • Varies for the decision being made • Altered by drugs, alcohol and emotional distress
What should we do? • Most patients will consent to treatment • If patients don’t consent then an assessment of capacity must be made • If the patient has capacity then their decision must be respected • If the patient lacks capacity then they can be given treatment which is in their best interests • If there is doubt err on the side of caution
Study conclusion • More training is needed!!
