Capacity is the ability to give consent. It relies on the patient being able to understand the risks and benefits and make a decision.
Capacity is important because you need to know if a person can give consent.
Patients aged 18 or over are assumed to have capacity unless this is proven otherwise. The Mental Capacity Act 2005 governs this.
In order to have capacity, a person must:
If someone lacks capacity, it means they don’t meet the points above. It may be permanent, or temporary (for example if they’re on medication or under the influence of substances).
In this situation, the Doctor is expected to act in the best interest of the patient.
Someone who has a permanent lack of capacity may have a medical proxy, who’s able to make decisions for them, or they may have an advanced directive in place.
Consent is when a patient gives permission before receiving any form of medical treatment, examination or test.
Adults are generally able to give consent, but there are times when this isn’t true (see capacity below). In the case of young children, their guardians are able to give consent on their behalf. Consent is trickier when it comes to young adults – but you need to understand the issues, so you can treat them appropriately and safely.
Consent is an important issue to consider when dealing with medical ethics scenarios because it means the patient has agreed to what is about to happen to them. It also enables patients and healthcare professionals to work together to make important decisions.
Consent is valid when all three of these criteria are met:
Consent is given in two main ways:
The Children Act 2004 (a reinforcement of TCA, 1989) states that adulthood is reached after the 18th birthday. This means 18-year olds are to be treated like all other adults that are able to consent for themselves unless there are exceptional circumstances.
16 and 17-year-olds are presumed to be able to make decisions about their health independently from their parents and are usually able to consent for themselves.
It’s typically under 16s that must be assessed for competency to consent before being able to agree to an intervention. This is known as Gillick competency.
If a child is unable to demonstrate this competence, then the following can consent on their behalf:
Here are some examples of when patient consent applies:
In some instances, treatment may proceed without a patient’s consent in situations such as:
Consent is a difficult concept, particularly when it comes to children and young people. You should apply the four pillars of ethics to any dilemmas about consent.
When it comes to autonomy, you should think about:
This means that a child should not be able to consent to a test or treatment if they cannot understand the intervention and its accompanying risks and benefits.
For beneficence, think about:
This is particularly important when children refuse treatment. If refusing treatment may result in serious mental or physical harm, the decision may be overruled by a parent or a court of law, to ensure the best interests of the child are prioritised over autonomy.
When it comes to non-maleficence, consider:
It is important to consider whether the child is put at risk from treatment or a lack of treatment.
For justice, make sure to think about:
The test states that if a child can understand and comprehend a treatment, its implications, including the risks and benefits, and alternative options, they have the ability to consent.
To get a better understanding of applying key pillar of ethics to consent and young children, it is worth looking into the recent Keria Bell case.
Below is a consent scenario to consider:
A 15-year-old girl comes in alone and tells her GP that she is sexually active. She also states that she would like to start taking contraception.
When it comes to capacity and consent, you should consider:
However, consider if the girl was engaging in sexual activity with an inappropriate adult, the situation would change. By providing treatment, you may be allowing the behaviour to continue and remain a secret from the parents, both of which would put the child at risk of harm. In this instance, Gillick competence is very important and will help the GP understand whether sexual abuse is taking place, whether the child’s safety is at risk and whether the child is able to consent to sexual activity.
For the specific case of contraception in under 16s, it may be valuable to familiarise yourself with the Fraser guidelines.
It is possible you will encounter questions about capacity or consent in your interview. Some topics that could arise are:
To find out the answer to these questions, check out our ethics question and answer guide.
Loading More Content