1. Consent & Vulnerable Adults Aim: To provide an opportunity for Primary Care Staff to explore issues related to consent & vulnerable adults

2. Learning Outcomes: Discuss the meaning of consent, including factors that determine whether or not consent is valid Explain the meaning of “capacity” to consent to treatment. Be aware of proposed ICP on consent

3. Begin to explore legal provisions for treating patients who can not consent To explore how issues of consent affect an individual’s practice Be aware of where to access additional information Learning Outcomes: (2)

4. Consent “ Refers to a person giving permission, expressing willingness to entering into a voluntary agreement.”

5. Capacity “Relates to the issue of whether a person is competent to make a decision and if not, who is able to make a decision to give treatment.”

6. Vulnerable Adult “is or maybe on need of community care by reason of mental or other disability, age or illness and who is or maybe unable to take care of his or herself or unable to protect him or herself against significant harm or exploitation” (Law Commission Report 231 1995)

7. Think about a situation when you were asked to consent to treatment or to some form of medical procedure such as having a blood test. What factors do you think needed to be present for you to have been able to agree to the treatment or procedure?

8. Consent – The Facts! The legal framework of English law states that: No one can give consent on behalf of another adult It must be assumed that a person can make their own decisions unless proven otherwise

9. It is the responsibility of the treatment provider to make a decision about the persons capacity to consent to treatment. It is a criminal offence to treat a person who has not consented Consent – The Facts! (2)

10. Factors that determine whether or not consent is real Has the person been given information about the treatment? Has the person made the decision of their own free will? Has the person sufficient capacity to make the decision?

11. Scary bit! If a patient has capacity to consent & treatment is given in the absence of consent, the patient can bring civil action for “trespass to person” against the person treating him or her Additionally, the person carrying out the procedure can be prosecuted under the common law of “assault & battery” or under the offences against the person act 1861!

12. However! Health professionals & carers can influence the following decisions: Whether a person has / has not the capacity to give valid consent to the proposed treatment Whether the proposed treatment should be carried out under the “best interest” option

13. Is “Yes” good enough? Vulnerable adults may have: Lived in an environment where unquestioning compliance is rewarded May be susceptible to the influence of authority figures, such as practitioners People may always choose the last option offered People may always say either “yes” or “no” They may not know they have a choice in accepting or declining.

14. What happened? Who did it involve? What did you do? What was the outcome? Could you have done anything differently?

15. Draft Mental Incapacity Bill The Green paper" Who decides” (1997) and policy statement “Making Decisions” (1999) Lord Filkin said: “clear, simple informal system that will ensure people can maintain a maximum level of autonomy”

16. Key aspects Recognition that a person’s capacity to make a decision is dependent on the complexity of the decision and that it may vary from time to time A statutory definition of when a person may be regarded as unable to make a decision

17. A statuary definition of “best interests” A requirement that all practical steps be taken to facilitate decision making A general authority that makes if lawful to act on someone's behalf, who lacks capacity, where it is reasonable for the person to do so and is in a persons best interests. Key aspects (2)

18. A new “lasting power of attorney” which covers personal welfare, including medical treatment, as well as property & affairs A new “advance decision to refuse treatment” Key aspects (3)

19. People are unable to make a decision for themselves if: They are unable to understand the information relevant to the decision They are unable to retain the information

20. They are unable to use the information as part of the process of decision making They are unable to communicate the decision(whether by talking, using sign language or any other means)

21. Factors to be considered when thinking about acting in a person’s best interest Will the person have capacity in relation to the matter in question at some time in the future? The importance of people being permitted and encouraged to participate as fully as possible in acts done for them & decisions made for them

22. Have the individual's past & present feelings and wishes been taken into account? Have the views of specified person, such as any person engaged in caring for the person, been taken into account? Determine whether the procedure can be carried out in a manner less restrictive of the persons freedom

23. What does this mean for practice? Always use a multi-disciplinary approach in all decision making Ensure as far as possible that the person is informed of proposed treatment in a manner understandable to them Refer to local policies

24. Record keeping Keep clear & concise records of all stages of the process Include any disagreement between the clinical team & those close to the person Keep records of patients assessment of capacity

25. Consent form 4 Why the health professionals believe treatment to be in best interests Involvement of people close to the patient Record keeping (2)