Capacity and Consent: Understanding the Implications for Nursing Practice
Norma LeBlanc
C00425167
University of Louisiana Lafayette Introduction
Most people value the right to choose and on a daily basis make many choices concerning a wide range of things that impact their lives including whether to follow medical advice. When making these decisions, people will usually consider all the available options, and choosing the course of action that suits them best. A person uses the same process when choosing his/her heath care options.
The right to choose is protected by the ethical principle of autonomy (Burkhardt and Nathaniel, 2014), and is supported both in law (Mental Capacity Act 2005) and health-care policy (Department of
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If an adult patient refuse to give their consent and are deemed to have the mental competence or ‘capacity’ to do so, health professionals are not permitted to provide care or treatment, even in the event that this may cause the person lasting, preventable health damage, or result in death. Capacity and consent are important issues in contemporary healthcare, and issues of which nurses in all fields of practice need to have a good understanding. This paper discusses what is meant by the terms ‘capacity’, ‘consent’ and ‘informed consent’, and explores the legal, ethical and professional obligation to obtain patient consent for all healthcare treatments.
What is Consent?
Inherent in nursing practice is recognition of the right of people to make informed decisions and to formally consent (or refuse to consent) to care and treatment related to their health needs. The word “consent” is used frequently in healthcare. Consent to treatment is 'the principle that a person must give their permission before they receive any type of medical treatment or examination’ (NHS Choices, 2016).
A patient’s consent can be implied or expressed. Expressed consent is an oral or written authority by the patient to render the proposed treatment. Consent for routine blood work and x-rays, urine samples are considered
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States have recognized the right of parents to make health care decisions on their child’s (younger than 18) behalf in 46 states. The exceptions to this rule are medical emergencies when there is no time to obtain parental consent and in cases where a minor is "emancipated" by marriage.
Some adult patient seeking treatment may not have the capacity to give consent. There are principles that must be adheres to when assisting patients with limited capacity. These principles include the inability to: (1) Act; (2) Make decisions; (3) Communicate decisions; (4) Understand decisions; and (5) Retain the memory of decision. Where a patient lacks decision-making capacity, courts may make a declaration that treatment can be given lawfully, even without the patient’s consent.
What is informed
Consent is necessary from everyone, not only those who can verbalise his or her needs. It is important to find out the persons communication needs so that they can be involved in discussions around their needs and preferences. My duty of care is to ensure that choices are given, and that appropriate support is obtained where there is lack of capacity is the decision is complex and the individual cannot consent. This may be from families or next of kin or using advocates to ensure that the client’s best interests are maintained. There may be past events or requests that could indicate the client’s preferences, and these must be considered when choices have to be made by others. Any preferences should be recorded on care plans and shared with relevant others to be able to determine the best interests of the person. Decisions should also be put off until the client is able to make their own choices where possible and not taken on their behalf through assuming we know
In this context, new emphasis is being placed on the rights of patients. Recent federal legislation, for example, requires all health care facilities receiving Medicare or Medicaid monies to inform patients of their right to make medical treatment decisions. This includes the right to specify "advance directives," [1] which state what patients wish to be done in case they are no longer able to communicate adequately.
Informed consent is the basis for all legal and moral aspects of a patient’s autonomy. Implied consent is when you and your physician interact in which the consent is assumed, such as in a physical exam by your doctor. Written consent is a more extensive form in which it mostly applies when there is testing or experiments involved over a period of time. The long process is making sure the patient properly understands the risk and benefits that could possible happen during and after the treatment. As a physician, he must respect the patient’s autonomy. For a patient to be an autonomous agent, he must have legitimate moral values. The patient has all the rights to his medical health and conditions that arise. When considering informed consent, the patient must be aware and should be able to give a voluntary consent for the treatment and testing without being coerced, even if coercion is very little. Being coerced into giving consent is not voluntary because others people’s opinions account for part of his decision. Prisoners and the poor population are two areas where coercion is found the most when giving consent. Terminally ill patients also give consent in hope of recovering from their illness. Although the possibilities are slim of having a successful recovery, they proceed with the research with the expectation of having a positive outcome. As stated by Raab, “informed consent process flows naturally from the ‘partnership’ between physician and patient” (Raab). Despite the fact that informed consent is supposed to educate the patients, it is now more of an avoidance of liability for physicians (Raab). Although the physician provides adequate information to his patient, how can he ensure that his patient properly ...
Recent developments in standard of care and professional relationship with patients have made law fundamental to the study and practice of nursing. At every stage of patients care, law helps bring up to date nursing practice and it is essential that nurses understand the legal and ethical implications of law in their nursing profession (Griffith and Tengrah, 2011). The purpose of this essay is to discuss the concept of consent in relation to the role of the nurse. This will aim at demonstrate ethical and legal implication of consent on nursing practice and professional working. In the Code (2008, cited in Griffith and Tengrah, 2011) the Nursing and Midwifery Council set standards for nursing professional to follow. Among the rules is the requirement of nurses to obtain consent before care is given.
In Amira’s case, an issue of consent is arisen that her GP has not explained to her much about the conditions she is suffering and the medication that he prescribed. Amira was left a little confused because she did not has the chance to ask questions. For obtaining consent, it must be informed and capacity which means that Amira must be given all of the information of the treatment and they understand the information provided by the doctor and they can use it to make a decision (13). Obtaining consent will lead to enhancement of the efficiency to the treatment because Amira is happy and showing agreement to the
An ethical dilemma is defined as a mental state when the nurse has to make a choice between the options and choices that he or she has at her disposal. The choice is a crucial task as the opting of the step will subsequently determine the health status of the concerned patient, hence it requires a great deal of wisdom along with proper medical and health training before any such step is opted as it is a matter of life and death. Strong emphasis should therefore be on the acquisition of proper knowledge and skills so that nurses do posses the autonomy to interact with patients regarding ethical issues involved in health care affairs and address them efficiently. It is normally argued that nurses are not provided sufficient authority to consult and address their patients on a more communicative or interactive level as a result of which they are often trapped in predicaments where their treatments of action and their personal beliefs create a conflict with the health interests of the patient. (Timby, 2008)
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
Any act done or decision made on behalf of an individual deemed to lack the capacity (following a capacity assessment), must be done in their best interests, this can cover financial, health and social care decisions.
According to the NICE (2015) health and social care professionals should always seek valid consent from people with dementia. This should entail informing the person of options, and checking that he or she understands, that there is no coercion and that he or she continues to consent over time. If the person lacks the capacity to make a decision, the provisions of the Mental Capacity Act 2005 must be followed. The nurse assessed the patient capacity and ensured that the decision made was in the best interest of the patient. The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient (GMC, 2008). They took into consideration how the decision made will benefit Jean. After carrying out a full assessment, it was clear that Jean lack capacity and was therefore place under the mental capacity act
We must be able to openly listen to our patients needs and communicate effectively in order to empower our patients. They need to know that we are listening, that we understand, and that we are going to provide them with the knowledge and information needed to make their own choices. We must first be empowered in order to help empower them. Constraints Empowering our patients can be very difficult when we are faced with institutional and professional constraints.... ...
Katharine Evans,James Warner, Elizabeth Jackson. (2007). How much do emergency healthcare workers know about capacity and consent?.Emergency medical journal. 24 (6), 391-393.
Advocates of this issue believe that minors should have the right to be in charge of their medical decisions. Dr. Eric Kodish believes that decisions made by teenagers on the older side who are able to make a righteous decision should be carried out. “I think the ethics of modern American life suggest that if people have the capacity to make a decision, they should be free to refuse treatment” (Shute 1). Advocates of minors being able to make their own medical decisions believe that if the minor shows enough maturity understanding of their desired action, then it should be respected and carried out. Dr. Eric Kodish uses what he calls “The Rule of 7s” to determine when a child should be allowed to make the decision.
The Health Care (Consent) and Care Facility (Admission) Act (HCCFA) Section 12 (1996) , “permits health care for adults to preserve life, to prevent serious physical or mental harm or to alleviate severe pain when an adult is incapable of giving consent and there is no appropriate substitute decision maker available.” For example, applying a soft restraint to a physically aggressive adult who is incapable of consenting to treatment due to be intoxicated by alcohol or drugs (Canadian Registered Nurses of British Columbia,
The American Nurses Association Code of Ethics for Nurses has five elements that pertain to the Principle of Autonomy. Each individual element applies to “respect individual persons” (Baillie, McGeehan, Garrett T, M., Garrett R. M., 2013, p.33). In Chapter 2 of the Health Care ethics: Principles and problems text, it discusses thouroghly the consent of an individual to make their own decisions regarding their health and future requests of care. As a nurse or within all heath care professions, we must treat each individual patient with care, respect, and to remain mindful to the patient regarding any aspect of their lives. In the ANA Code of Ethics for Nurses, it explains ways of maintaining the empathy required in the health field. It further discusses that the respect for human dignity must be a priority, relationships to patients must remain neutral, the severity of the situation, the right to self-rule, and the professionalism that must be upheld by the nurse and their associates.
Another huge ethical topic is the patient’s right to choose autonomy in the refusal of life-saving medicine or treatment. This issue affects a nurse’s standards of care and code of ethics. “The nurse owes the patient a duty of care and must act in accordance with this duty at all times, by respecting and supporting the patient’s right to accept or decline treatment” (Volinsky). In order for a patient to be able make these types of decisions they must first be deemed competent. While the choice of patient’s to refuse life-saving treatment may go against nursing ethical codes and beliefs to attempt and coerce them to get treatment is trespass and would conclude in legal action. “….then refusal of these interventions may be regarded as inappropriate, but in the case of a patient with capacity, the patient must have the ultimate authority to decide” (Volinsky). While my values of the worth of life and importance of action may be different than others, as a nurse I have to learn to set that aside and follow all codes of ethics whether I have a dilemma with them or not. Sometimes with ethics there is no right or wrong, but as a nurse we have to figure out where to draw the line in some cases.