Medical Treatment: Decisions and the Law

2. Consent & Capacity – Adults

Co-authored by Michael Walsh and Jemma Lee.

Contents

  • A  Adult  2.1
  • B General rules  2.2
  • General rule 1: A capacitous adult’s wishes must be respected 2.2
  • General rule 2: There is only limited proxy of consent for others 2.3
  • General rule 3: Power to treat in an incapacitous person’s best interests  2.4
  • C Capacity  2.5
  • Presumption of capacity 2.5
  • Definition of capacity 2.6
  • The specific decision 2.8
  • Capacity is decision-specific: what must be considered is capacity to make the specific decision that has to be made 2.8
  • The relevant information  2.9
  • Key to any assessment of capacity is the identification of the information relevant to that specific decision 2.9
  • Establishing capacity to consent, as opposed to obtaining ‘informed consent’ 2.10
  • The ‘limbs’ of the functional test in section 3  2.11
  • (a) Understanding the relevant information  2.11
  • (b) Retaining the relevant information  2.12
  • (c) Using and weighing the relevant information  2.13
  • (d) Communicating the decision 2.15 Unwise or irrational decisions 2.16
  • The assessment of capacity  2.17
  • Key principles in determining capacity 2.17
  • The steps to be taken to assess capacity 2.18
  • Guidance on the assessment 2.19
  • Recording capacity assessments 2.20
  • The court makes the decision 2.21
  • Temporary incapacity 2.22
  • Anticipated loss of capacity – Guy’s and St Thomas’s NHS Foundation Trust v R 2.23
  • D Consent  2.24
  • The absolute nature of an adult’s consent 2.24
  • Treatment must be lawful 2.25
  • The obligation to treat in accordance with expressed wishes 2.26
  • E Refusal 2.27
  • Capacitous decisions to refuse treatment that may accelerate death 2.28
  • Case of Ms C 2.29
  • Obstetric treatment in the interests of a viable foetus no exception  2.30
  • F Change of mind  2.31
  • G Advance decisions 2.32
  • General principle 2.32
  • Advance decisions under the MCA 2.33
  • Validity 2.34
  • Applicability  2.35
  • Advance decisions and MHA s 63 2.37
  • Form 2.38
  • Informed refusal?  2.39
  • Knowledge  2.40
  • Duration  2.41
  • Records  2.42
  • H Conclusion  2.43

 

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