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Test yourself on values, laws and ethics knowledge with this quiz on how consent and capacity are used in the emergency department 

Reviewed by: Jonathan Loomes-Vrdoljak, 28 February 2020

Treatment in the Emergency Department

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Question 1
What is required for consent to be valid? Select all that apply
A
Capacity
B
Voluntariness
C
Autonomy
D
Sufficient information
E
Necessity
Question 1 Explanation: 
There are three aspects needed for consent to be valid. An individual giving consent must have capacity to make that choice. The individual giving consent must be free from coercion and be giving the consent voluntarily. The individual must have sufficient information to understand their decision.
Question 2
What does the doctrine of necessity allow?
A
Treatment of individuals detained under the Mental Health Act
B
The treatment of children without parental consent
C
Immediately necessary treatment of an individual to save their life or prevent serious deterioration of their condition without their consent
D
Restraint of an individual
E
Lasting power of attorney to be given to an individual of the patient's choice
Question 2 Explanation: 
The Doctrine of necessity is a common law that allows “When an emergency arises in a clinical setting and it is not possible to find out a patient’s wishes, you can treat them without their consent, provided the treatment is immediately necessary to save their life or to prevent a serious deterioration of their condition. The treatment you provide must be the least restrictive of the patient’s future choices.”
Question 3
With regards to restraint, select the statements below that are true.
A
The doctor restrains the patient if they threaten to use force to secure the act that the patient resists
B
Restraint can be used to prevent harm to the patient
C
Restraint can only be used when necessary
D
Restraint must be proportionate to respond to the patient
E
A doctor restricts a patient if they restrict the patient's movements, whether or not the patient resists
Question 3 Explanation: 
All of the statements are true. Restraint must only be used when it is necessary to prevent harm to the patient. The restraint must be proportional to the likelihood of the patient's harm and the seriousness of the harm. It is restraint if you threaten the use of force for example "Sit down or I will make you" and if you use force.
Question 4
A patient is brought into the Emergency Department with their partner, following a stroke. The patient lacks capacity at this moment and is unable to communicate or respond. The medical team explain to the patient and their partner that the patient requires emergency neurosurgery. The partner begs the medical team to operate as "It's what the patient would want!" What will help inform the medical team of the best interests of this patient?
A
The age of the patient
B
That the patient has previously communicated they would want an operation if they had a stroke.
C
The medical team judge the patient to lead a non-mainstream lifestyle and make assumptions that they may prefer alternative therapies
D
The partner states an operation is what the patient would want
E
The patient has a diagnosis of a chronic medical condition
Question 4 Explanation: 
The guidance on dealing with a situation like this is quite clear "‘Where the determination relates to life-sustaining treatment he must not, in considering whether the treatment is in the best interests of the person concerned, be motivated by a desire to bring about his death. He must consider, so far as is reasonably ascertainable— (a) the person’s past and present wishes and feelings (and, in particular, any relevant written statement made by him when he had capacity), (b) the beliefs and values that would be likely to influence his decision if he had capacity, and (c) the other factors that he would be likely to consider if he were able to do so.’ ‘In determining for the purposes of this Act what is in a person’s best interests, the person making the determination must not make it merely on the basis of— (a) the person’s age or appearance, or (b) a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about what might be in his best interests.’"
Question 5
A child is brought into the emergency department following a fall with a suspected fractured radius and ulna. Who has parental responsibility under the Children Act 1989? Select all that apply
A
Mother by default
B
Father by default
C
Father if registered on birth certificate
D
Father if married to Mother at time of child's birth
E
Mother by court order
Question 5 Explanation: 
Parental responsibility (under Children Act 1989) is with: • Mother responsibility by default. • Father if married to mother at time of child’s birth (or marries mother after birth), or • if registered on birth certificate, or • by Parental Responsibility Agreement with mother, or • by various kinds of court order
Question 6
A person is brought to the Emergency department with a suspected community acquired pneumonia. Their condition is not immediately life threatening, but they require intravenous antibiotic therapy. They have advanced dementia and lack capacity at this moment. From whom may proxy consent be gained?
A
The patient's spouse by default
B
A person with lasting power of attorney previously appointed by the patient
C
Proxy consent is not needed as the doctrine of necessity means the medical team may treat the patient without consent
D
A court appointed deputy
E
The patient's child/children
Question 6 Explanation: 
Proxy consent may only be given under two conditions: Previously appointed lasting power of attorney by the patient and by a court appointed deputy. The doctrine of necessity cannot be applied here as the patient is not in a life threatening or time critical situation. Spouses and/or children do not automatically gain the ability to provide proxy consent.
Question 7
A 45 year old is brought in following a motorcycle crash. They have sustained numerous fractures including ribs, pelvis and femur for which they require surgery within the next 48 hours. The patient is in considerable pain and is unable to concentrate on what the surgeon is explaining to them.  How may the medical team facilitate the patient to regain their capacity and give or withhold their consent for surgery? Select all that apply
A
Give analgesia to control the pain
B
Move them to a quieter environment so not to overwhelm them
C
Delay surgery by 24 hours to allow them time to regain capacity
D
It is in their best interests to have the surgery so go ahead without consent.
E
Support and reassure the individual
Question 7 Explanation: 
When time allows we should do everything possible to facilitate an individual to have capacity. Analgesia can be enough to allow someone to regain capacity. A quieter environment and supporting them may allow them to regain capacity. Delaying surgery, if it is not time critical, can allow someone time to regain capacity. It would not be appropriate to operate without consent as the doctrine of necessity would not apply.
Question 8
In order for an individual to have capacity, what must they be able to do? Select all that apply
A
Understand the information necessary to make a decision
B
Be literate to write down their decision
C
Retain the information long enough to make a decision
D
Weight up the information to come to a decision
E
Communicate their decision by whatever means
Question 8 Explanation: 
In order for a patient to have capacity, they must be able to do all of the following: • Understand the information necessary to make a decision; • Retain the information long enough to make a decision; • Weigh the information; • Communicate their decision; A person does not have to be literate to communicate their decision. A person can communicate their decision through many different means such as verbal, written, sign language and communication devices. You must assume capacity and the onus is on showing a patient lacks capacity
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