CONSENT

See Decision Tree for Consent

See Discharge against medical advice

See Forensic alcohol sampling

PRINCIPLES

  • A patient can personally accept or refuse an intervention only if:

AND

  • You are obliged to intervene only if the condition is LIFE-THREATENING and the patient is NON-COMPETENT and there is NO CONTRAVENING LEGAL DIRECTIVE
  • In NON-URGENT conditions, it is advisable but not necessary to obtain direction from a legal authority e.g. parent, guardian, court before treating a non-competent patient

Hence,

  • Any condition + Competent patient + No consent + Intervention = ASSAULT
  • Non-life threatening condition + Non competent patient + No consent + Intervention = ASSAULT
  • Life threatening condition +  Non-competent patients + No prior legal directive + No intervention =  NEGLIGENCE 

COMPETENCY

  • A patient demonstrates competency if they demonstrate appropriate understanding, insight and judgement regarding the decision they make and the immediate consequences that may result

See Competency

THE AGE OF CONSENT

  • Age at which individuals (assuming there is no other reason not to do) are automatically given the right to accept or refuse medical treatment/procedure (age of consent) without interference
  • Age of consent = 14 (NSW) 16 y.o. (S.A) 18 y.o. (all other states)
  • Age of itself is not a determining factor of competence
    • The choices that they are capable of making depends on the individuals understanding and maturity
    • It may vary according to what choices they are offered e.g. a 10 year old may be able to agree to have a plaster case applied but not to major elective surgery
    • A child may be capable of making choices but unlike an adult can have their decisions challenged by a parent/guardian (and may eventually need to be settled in court)
  • Although advisable, it is not necessary to obtain the consent of a parent/guardian if you are satisfied with the patients competency (see Right to privacy)

URGENT CONDITIONS

  • The urgency to treat exists on a spectrum e.g. CPR in an arrest, thrombolytics for MI, blood transfusion for haemorrhage, surgery for ruptured appendix
  • If possible always obtain some form of consent first - else treat

 

Disclaimer: Note: The information described here relates solely to operational matters in the Emergency Department.  Every effort has been made to verify the accuracy of the content. However, neither the author or the hospital will take responsibility for errors resulting from its use.  Please refer to your own departmental guidelines and verify all clinical decisions with a reliable source.  

Date Last Reviewed: 05/08/2004