Threshold element

• Competence: Is the person capable of giving consent (ie do they have capacity? are they well enough? Are they a child? Are they mentally competent?) This threshold element protects against harm
  • The common law test is that a person will have capacity to make decisions about medical treatment if they are able to:
    • comprehend and retain the information needed to make the decision, including the consequences of the decision; and
    • use and weigh that information when deciding.

.Information elements

• Disclosure of information
  • Risk/benefits information should be disclosed based on what the patients wishes to know (patient-centred). In addition, even if the patient did not ask, it is the doctors duty to disclose information that would reasonably be required by a person in that position
• Understanding of information
  • You may disclose the information, but did the patient understand it? Was the language ‘free of jargon’? Was the language and information sensitive to the patients culture/ values/gender issues?

Consent elements

• Voluntariness
  • Was the consent freely given? Or was there undue influence/ manipulation (coercion
• Authorisation
  • Are you the person authorized to seek consent? Is the consent documented (ie written)?

Situations where the person may lack capacity for informed consent include brain injury (such as a stroke causing Wernicke’s aphasia) or them being unconscious, the person having dementia or the patient being a child

Dementia and consent

• It should not be assumed that just because someone has dementia, they are unable (lack capacity) to make their own decisions. People with dementia should be supported in making their own decisions about their care and day to day life for as long as possible. Dementia can affect a person’s ability to make decisions because it can affect the parts of the brain involved in remembering, understanding and processing information. This does not necessarily mean that a person with a diagnosis of dementia lacks capacity to make decisions – capacity is time and decision specific.

Brocas aphasia and consent

• In Wernicke’s aphasia, the ability to grasp the meaning of spoken words and sentences is impaired, while the ease of producing connected speech is not very affected.

Children and consent

• For children and young people under 18, a parent or guardian can agree to treatment on the child’s behalf (in most cases).