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Confucius

Query about consent/capacity

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I work in Learning disability and have an IN PATIENT who is due to have endoscopy. he clearly does not have the capacity to consent and thus Form 4 (unable to consent form) has to be filled.

who should be filling it - the radiologist or us. the radiologist says he does not know the patient and so will not be filling the form.

I think thats rite but my consultant disagrees.

Please help. ( references would be great) i have had a look at the DH site but found it non-specific.

Ta.

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Any doctor should be able to assess capacity to consent or refuse treatment especially with regards to endoscopy which is a simple procedure to explain.

The Radiologist might be feeling less confident because your patient has LD.

Same way, your consultant seem to be feeling less confident because he may not be able to explain the procedue, complications etc to the patient, im not sure whether its due to lack of knowledge or because he thinks its the job of Radiologist, hence he should do it.

Cant think of a reference ( vaguely remember an article by Thomas and someone in 2002ish, xyz journal, not BJP nor BMJ nor APT, some not so famous Journal).

Bottomline is, its not as big an issue as its being made of, im sure if one of them attempts to assess the capacity, they will see the way forward. If its really complicated, both of them should get together to make the assessment.

Are you a member of MDU? if yes, speak to them for advice as to what you should do in this kind of situation, patient should not suffer due to undue delay. To cover yourself, write letter to radiologist explaining your consultants views rather than speaking on phone and keep a copy in case notes. Let them sort it out between themselves.

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thank you DKS. i did fill the form in the end though my consultant wasnt convinced. but the patient is havin the endoscopy today. :)

I think the issue got complicated b'coz we had actually requested the endoscopy n the radiologist was just performing it.

i think if we can reguest an investigation we should be able to consent for it.

but its worked out in the end to the benefit of the patient.

Thank you again.

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'I think if we can request an investigation we should be able to consent for it.'

That is a good point. You can refer to another discipline who could then go on to request an investigation that they might have to do the consent for; but if you're requesting the investigation yourself it does imply you know what you're asking for. Hence you should have enough knowledge to gain the patient's consent (or otherwise).

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well it is an interesting point...

I think that although you may know what you are requesting, you may not know all the practicalities around it, so requesting something does not mean you know all aspects of it, hence you might not need to get the full consent

and by the end of the day, the person performing the investigation should ideally get consent as well, as they cannot rely on you doing it on their behalf

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that may be true in certain instances BUT in this case the radiologist was performing the investigation just like he would perform a CT scan/X-ray and would probably perform several each day.

How practical is it to expect him to talk and explain the procedure, risk... to each n every pt. ?

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The person who is performing the procedure has to make the decision about the procedure. He/She should decide on the capacity to consent.

Anyone can request a procedure.For eg, a consultant may want blood investigations done on, say LD patient. And if , say SHO were to do it and does that without consent and not in an emergency, who would be liable?I think its the SHO.

Ofcourse, as we are considered specialists in LD, we can assist others with our opinions. But at the end of the day, the doctor who does the procedure takes the cake.

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Anyone can request a procedure.For eg, a consultant may want blood investigations done on, say LD patient. And if , say SHO were to do it and does that without consent and not in an emergency, who would be liable?I think its the SHO.

I don't think its as easy as you are assuming in the above scenario. 'without consent'- if the patient doesn't resist, it's presumed that he is consenting. If he resists, he will need to be physically restraint, and the nurses will not allow/co-operate with it unless you give them a valid explanation.

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THe GMC states very clearly in its document 'Seeking Patients' consent: the ethical considerations' (Nov 1998)

Who obtains consent

14. If you are the doctor providing treatment or undertaking an investigation, it is your responsibility to discuss it with the patient and obtain consent, as you will have a comprehensive understanding of the procedure or treatment, how it is carried out, and the risks attached to it. Where this is not practicable, you may delegate these tasks provided you ensure that the person to whom you delegate:

- is suitably trained and qualified;

- has sufficient knowledge of the proposed investigation or treatment, and understandsthe risks involved;

- acts in accordance with the guidance in this booklet.

You will remain responsible for ensuring that, before you start any treatment, the patient has been given sufficient time and information to make an informed decision, and has given consent to the procedure or investigation.

The responsibility lies with the doctor who carries out the procedure, not the one who refers the patient.

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Anyone can request a procedure.For eg, a consultant may want blood investigations done on, say LD patient. And if , say SHO were to do it and does that without consent and not in an emergency, who would be liable?I think its the SHO.

I don't think its as easy as you are assuming in the above scenario. 'without consent'- if the patient doesn't resist, it's presumed that he is consenting. If he resists, he will need to be physically restraint, and the nurses will not allow/co-operate with it unless you give them a valid explanation.

I agree it is a simplistic assumption. My point was : responsibility rests with the person that actually does the procedure.

I do ofcourse agree not resisting could be considered as consent, though with caution.

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