Consent Mark with airSlate SignNow

Esign child medical consent

hi I'm dr. ha Pinto and we're going to talk today about consent and this is in continuation of our medical ethics lecture series okay so what is consent consent it defined as a permission for something to happen or an agreement to do something in the context of medicine this involves a patient providing permission or in other words consent for a treatment or an investigation gaining consent is the ethical and legal duty of that doctor okay so when a doctor requests consent from a patient this can be provided either as one written consent for example in the case of a consent form for an operation oral consent for example when we're asking if we can examine a patient it's imperative though that we ensure that this is documented clearly in the notes and three implied consent for example if we're taking our phlebotomy equipment to the patient and they lean out their arm for us to take their blood ideally this should be avoided where possible as it may be misinterpreted by the doctor we should also note that written consent is the most legally substantiated and implied consent is the least legally substantiated so why is consent important all persons have a legal right to preserve their body integrity if consent is not obtained by a doctor they would violate this legal right and therefore could be sued for battery against a patient a doctor who does this will be seen as medically negligent and could in very be sued or brought in front of the General Medical Council and their clinical practice questioned consent is also important because it maintains a good doctor-patient relationship it increases the trust between patients and all doctors if the medical profession and a virtuous doctor would seek to obtain consent prior to performing any examination or treatment patients can refuse to give consent the law permits that competent adult has a right to refuse even life-saving treatment even if the doctor determines this is not in the best interests the patient's wishes must be respected patients also have the right even after providing consent for treatment or procedure they have the right to withdraw that consent at any time for example a patient undergoing an appendicectomy which may even be life-saving the patient can withdraw their consent for that operation even as they are about to be anesthetized doctors in that circumstance would need to reevaluate the situation we discuss the benefits and risks of not proceeding with the operation and should the patient make the informed decision that they don't want to proceed their wishes again must be respected moving on now so there are three criteria that must be fulfilled in order for consent to be valid firstly a patient must be fully informed about the treatment benefits the risks it must also be competent to provide concern and consent itself must be provided voluntarily without coercion so first of all looking at informed consent in order for a patient to provide valid consent they must be fully informed of the following the nature of the treatment and investigation being proposed why that treatment or investigation is required how the procedure will be performed the risks and benefits of the procedure including the possible side-effects alternative treatments that are available and the likely success of the treatment or investigation being performed competency for consent is a slightly more difficult concept to understand only a competent adult can provide valid consent where the patient is not competent they must be treated in their best interests using the ethical principle of beneficence family members have no legal right to provide consent for incompetent adults but their views should be considered patients greater than 18 years are legally determined to be competent adults unless proven otherwise children greater than 16 years have presumed capacity for consent children less than 16 years are presumed not to have capacity for consent unless this can be proven by the doctor using Gillett competence and Frasor guidelines we will discuss this later on so how do we determine if a patient is competent to provide consent a patient must be able to understand the relevant information being provided be able to retain that information for long enough to weigh up the pros and cons of the procedure or treatment being proposed and make an informed decision being able to communicate that to the doctor either by talking signing or in writing consent must be provided voluntarily without any undue coercion they must not be influenced by the doctor or the family doctors are solely present to advise and provide the relevant and required information this allows the respect of a patient's autonomy so now let's look at some special circumstances where consent may be problematic so doctors can provide treatment to patients without consent but only in the following circumstances in emergency situations with an incompetent adult where patients may be mentally ill and children less than the age of 16 years so where emergency life-saving treatment is required for an encompass entitled doctors should assess the patient's capacity and document their findings clearly in the patient's notes they must act in the best interest of the patient ie to prevent significant deterioration or provide life-saving treatment they must identify if there is a clear valid refusal of treatment that exists such as an advanced directive against CPR so the patient came in with cardiac arrest into our Amy Department and they had a community DNA CPR we must respect that previous decision and not perform cardiopulmonary resuscitation where a patient has a legal guardian this person should be consulted in reality it's always good practice to discuss these matters with the next of kin and other relatives and friends where patients are mentally ill this is covered by the Mental Health Act urgent treatment can be provided acting in the patient's best interests where one a treatment is required to save the patient's life to the treatment prevents a serious deterioration in the patient three it reduced serious suffering or for the patient's are in danger of self harm or harm to others consent in children is somewhat complicated we know that at 18 years a patient is legally considered an adult and therefore no person has the right to provide consent on behalf of them for children less than 18 years a parent or legal guardian has the right to provide consent parents or legal guardians must act in the patient's best interests where they don't doctors may seek to obtain a court order to proceed with treatment in these cases a doctor should seek advice from the hospital legal team for children aged 16 to 17 years they have presumed capacity for consent bursar Constance's are slightly different in that they are able to provide consent for treatment but they cannot refuse it and where they do refuse it an adult who has a parental or guardianship over that person can provide consent on their behalf children under 16 years on the Gillick competency and fraser guidelines they can legally provide consent but in order to do this the doctor must be a hundred percent satisfied that the child understands the treatment and can provide valid consent again the child cannot refuse treatment and the parent cannot overrule their child's wishes unless the child refuses the treatment in which case again the adult can provide consent on behalf of the child so realistically a child can provide consent and where that consent is provided their parent cannot withdraw the consent but where that child refuses to provide consent the parent or legal guardian has the right to overrule that and provide consent on the child's behalf here I have listed some suggested so the reading topics including the GMCs consent guidance the Mental Health Act of 2007 which we will cover in another subsequent lecture and the Mental Capacity Act all of which are relevant to the topics considered here thank you for listening to this lecture should you have any questions or any comments please leave them in the section down below and don't forget to subscribe for more ethical and medical lectures to come