Capacity & Consent
Capacity Assessments and Adults With Incapacity Act
All adults are presumed to have capacity to make decisions about their medical care. However there are some circumstances where an adult may lose their capacity to make a specific decision either temporarily or permanently.
It is key that capacity assessments are conducted and recorded accurately in our patient's notes, as highlighted by a recent report by the Mental Welfare Commission. If you are working in NHS Lothian there is a Trak cannedtext capacity assessment guidance tool. To access, type \capacity and then press space bar in clinical notes.
If a patient is found not to have capacity for a decision at that time, the Adults with Incapacity (Scotland) Act 2000 can be used and a Section 47 certificate, along with accompanying Annex 5 treatment plan should be completed.
It is necessary to seek consent before an examination or intervention. In some cases, such as physical examination or taking a blood sample, consent can be sought verbally and the patient’s subsequent cooperation in the process can be treated as ongoing implicit consent.
For more complex interventions a consent process needs to be undertaken and completed, to deliver a range of functions from a requirement to ‘decriminalise’ the ‘assault’ of surgery through to ensuring that informed persons can take part in shared decision-making about treatment options and thereby reduce subsequent decision regret around the planned treatment or intervention.